Polymyxin B versus colistin: an update.
Polymyxin B and colistin (polymyxin E) are polypeptide antibiotics that were developed in the 1940s, but fell into disfavor due to their high toxicity rates. These two antibiotics were previously regarded to be largely equivalent, due to similarities in their chemical structure and spectrum of activity. In recent years, several pertinent differences, especially in terms of potency and disposition, have been revealed between polymyxin B and colistin. These differences are mainly attributed to the fact that polymyxin B is administered parenterally in its active form, while colistin is administered parenterally as an inactive pro-drug, colistimethate. In this review, we summarize the similarities and differences between polymyxin B and colistin. We also discuss the potential clinical implications of these findings, and provide our perspectives on how polymyxins should be employed to preserve their utility in this era of multi-drug resistance.
a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore.|c 3 Department of Pharmacy, National University of Singapore, 21 Lower Kent Ridge Rd 119077, Singapore.
Yiying
Y
Cai
a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore.
Winnie
W
Lee
a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore.|b 2 Emerging Infectious Diseases, Duke-NUS Graduate Medical School, 8 College Rd 169857, Singapore.|c 3 Department of Pharmacy, National University of Singapore, 21 Lower Kent Ridge Rd 119077, Singapore.
Andrea L
AL
Kwa
D000818:Animals; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D003091:Colistin / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy; D007711:Klebsiella pneumoniae / Q000187:drug effects; D011112:Polymyxin B / Q000493:pharmacokinetics* / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D011112:Polymyxin B; D003091:Colistin
colistimethate sodium; colistin sulfate; multi-drug resistance; pharmacokinetics and pharmacodynamics; polymyxin B; polymyxin combination therapy; polymyxins; polypeptide antibiotics