title: Clinical considerations for optimal use of the polymyxins: A focus on agent selection and dosing.
abstract: Polymyxins have remained the drug of choice for treatment due to carbapenem-resistant Gram-negative bacilli. Unfortunately, the utility of these agents has been limited by a lack of pharmacokinetic understanding, a high toxicity rate, and an extremely narrow therapeutic index. Significant advancements have been achieved in the understanding of the polymyxins over the past decade, and have led to the recognition of several differences between available intravenous formulations. The purpose of this review is to discuss the implications of these differences, assess comparative efficacy and safety of the polymyxins, and provide recommendations for polymyxin dosing and selection.
authors.affiliation: Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, USA; Wayne State University of Medicine, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Pogue
authors.affiliation: Department of Pharmacy, Parkland Hospital and Health System, Dallas, TX, USA; University of Texas Southwestern Medical School, Dallas, TX, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Ortwine
authors.affiliation: University of Michigan Medical School, Department of Medicine, Ann Arbor, MI 48109, USA. Electronic address: keithka@med.umich.edu.
authors.forename: K S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003091:Colistin / Q000008:administration & dosage; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D011113:Polymyxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011113:Polymyxins; D003091:Colistin
keywords: Colistin; Dosing; Efficacy; Gram-negative; Nephrotoxicity; Polymyxin; Resistance