Adverse reactions associated with systemic polymyxin therapy

Pharmacotherapy. 2015 Jan;35(1):28-33. doi: 10.1002/phar.1493. Epub 2014 Sep 30.


The systemic polymyxins, colistin and polymyxin B, are increasingly used for multidrug-resistant bacterial infections and have a long history of dose-limiting toxicity. This review summarizes the most recent available information about the mechanisms, incidence, risk factors, and minimization strategies for polymyxin toxicity. Nephrotoxicity is related to polymyxin exposure with both size of dose and length of therapy associated with frequency. Newer studies have questioned conventional thinking that the relative risk of nephrotoxicity is lower for colistin than polymyxin B, especially in light of evolving dosing practices. Neurotoxicities and hypersensitivity reactions are less common than nephrotoxicity. New techniques to minimize or avoid polymyxin toxicities are now emerging including a growing interest in clinical assays for therapeutic drug monitoring and the development of novel, less toxic agents (e.g., polymyxin derivatives) for the treatment of multidrug-resistant bacterial infections.

Keywords: colistin; polymyxin; polymyxin B; toxicity.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / pharmacokinetics
  • Anti-Bacterial Agents / therapeutic use
  • Dose-Response Relationship, Drug
  • Drug-Related Side Effects and Adverse Reactions / etiology*
  • Humans
  • Kidney / drug effects
  • Nervous System / drug effects
  • Polymyxins / administration & dosage
  • Polymyxins / adverse effects*
  • Polymyxins / pharmacokinetics
  • Polymyxins / therapeutic use
  • Risk Factors


  • Anti-Bacterial Agents
  • Polymyxins