[Polymyxins - review with emphasis on nephrotoxicity].
Polymyxins are polypeptide antibiotics with strong action against Gram-negative bacteria. Their use was almost halted between 1970 and 1980 due to the launching of less toxic compounds. The emergence of multiresistant Gram-negative bacterial strains, mainly in patients hospitalized in intensive care units, and the absence of new antimicrobials effective against these pathogens, renewed interest in polymyxins in recent years. The major adverse effect of this class of antibiotics is nephrotoxicity. Currently, only polymyxins B and E are used in clinical practice. Polymyxin E, the compound more employed and studied, is known as colistin and is used in the form of sodium colistimethate, for the purpose of reducing its nephrotoxicity. There is no consistent data about prevalence of renal injury associated with use of the polymyxins or about the risk factors to develop nephrotoxicity with these antibiotics. The aim of this manuscript is to review the main aspects of polymyxin pharmacodynamics, to provide a better understanding about the mechanism of renal injury associated with them and to compare the different prevalences of renal injury described with the use of these antibiotics.
Mendes
Carlos Alberto Caldeira
CA
Serviço de Emergência Clínica, Unidade de Terapia Intensiva, Hospital de Base da Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP. cacaldeira@uol.com.br
Burdmann
Emmanuel A
EA
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D004285:Dogs; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D011113:Polymyxins / Q000009:adverse effects* / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D011113:Polymyxins