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The Great Debate: Polymyxin B Versus Polymyxin E

A quick breakdown of the pros vs cons of the two polymyxins appears at the end of this article (see Table). 

Krista Gens, PharmD, BCPS-AQ ID is in infectious diseases clinical coordinator at Abbott Northwestern Hospital, Minneapolis, MN, where she helps maintain antimicrobial stewardship programs at Abbott Northwestern and at several Allina Health regional hospitals. She is an active member of ACCP, ASHP, and SIDP.
Aileen Ahiskali, PharmD, is an infectious diseases pharmacist and antimicrobial stewardship program coordinator at Hennepin County Medical Center in Minneapolis, MN, where she coordinates antimicrobial stewardship initiatives and rounds with the infectious diseases team daily.

  1. Couet W, Grégoire N, Gobin P, et al. Pharmacokinetics of colistin and colistimethate sodium after a single 80-mg intravenous dose of CMS in young healthy volunteers. Clin Pharmacol Ther. 2011;89(6):875-879.
  2. Phe K, Lee Y, McDaneld PM, et al. In vitro assessment and multicenter cohort study of comparative nephrotoxicity rates associated with colistimethate versus polymyxin B therapy. Antimicrob Agents Chemother. 2014;58(5):2740-2746.
  3. Akajagbor DS, Wilson SL, Shere-Wolfe KD, Dakum P, Charurat ME, Gilliam BL. Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with polymyxin B in critically ill patients at a tertiary care medical center. Clin Infect Dis. 2013;57(9):1300-1303.
  4. Cheah SE, Li J, Tsuji BT, Forrest A, Bulitta JB, Nation RL. Colistin and polymyxin B dosage regimens against Acinetobacter baumannii: differences in activity and the emergence of resistance. Antimicrob Agents Chemother. 2016;60(7):3921-3933.
  5. Oliveira MS, Prado GV, Costa SF, Grinbaum RS, Levin AS. Polymyxin B and colistimethate are comparable as to efficacy and renal toxicity. Diagnostic Microbiol Infect Dis. 2009;65(4):431-434.
  6. Phe K, Lee Y, McDaneld PM, et al. In vitro assessment and multicenter cohort study of comparative nephrotoxicity rates associated with colistimethate versus polymyxin B therapy. Antimicrob Agents Chemother. 2014;58:2740-2746.
  7. Rigatto MH, Oliveira MS, Perdiago-Neto LV, et al. Multicenter prospective cohort study of renal failure in patients treated with colistin versus polymyxin B. Antimicrob Agents Chemother. 2016;60(4):2443-2449.
  8. Zavascki AP, Goldani LZ, Cao G, et al. Pharmacokinetics of intravenous polymyxin B in critically ill patients. Clin Infect Dis. 2008;47(10):1298-1304.
  9. Kalil AC, Metersky, ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111.
  10. Cheah SE, Wang J, Nguyen VT, Turnidge JD, Li J, Nation RL. New pharmacokinetic/pharmacodynamic studies of systemically administered colistin against Pseudomonas aeruginosa and Acinetobacter baumannii in mouse thigh and lung infection models: smaller response in lung infection. J Antimicrob Chemother. 2015;70(12):3291-3297.
  11. Benattar YD, Omar M, Zusman O, et al. The effectiveness and safety of high-dose colistin: prospective cohort study. Clin Infect Dis. 2016;62(12):1605-1612.
  12. Nation RL, Garonzik SM, Li J, et al. Updated US and European dose recommendations for intravenous colistin: how do they perform? Clin Infect Dis. 2016;62(5):552-558.
  13. Phe K, Shields RK, Tverdek FP, et al. Predicting the risk of nephrotoxicity in patients receiving colistimethate sodium: a multicentre, retrospective, cohort study. J Antimicrob Chemother. 2016;71(12):3585-3587.
  14. Rolain JM, Olaitan AO. Plasmid-mediated colistin resistance: the final blow to colistin? Int J Antimicrob Agents. 2016;47(1):4-5.
  15. Centers for Disease Control and Prevention. Tracking mcr-1. CDC Website. Updated November 30, 2016. Accessed December 1, 2016. 

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