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Toxicity of polymyxins: a systematic review of the evidence from old and recent studies

BACKGROUND: The increasing problem of multidrug-resistant Gram-negative bacteria causing severe infections and the shortage of new antibiotics to combat them has led to the re-evaluation of polymyxins. These antibiotics were discovered from different species of Bacillus polymyxa in 1947; only two of...

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Autores principales: Falagas, Matthew E, Kasiakou, Sofia K
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550802/
https://www.ncbi.nlm.nih.gov/pubmed/16507149
http://dx.doi.org/10.1186/cc3995
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author Falagas, Matthew E
Kasiakou, Sofia K
author_facet Falagas, Matthew E
Kasiakou, Sofia K
author_sort Falagas, Matthew E
collection PubMed
description BACKGROUND: The increasing problem of multidrug-resistant Gram-negative bacteria causing severe infections and the shortage of new antibiotics to combat them has led to the re-evaluation of polymyxins. These antibiotics were discovered from different species of Bacillus polymyxa in 1947; only two of them, polymyxin B and E (colistin), have been used in clinical practice. Their effectiveness in the treatment of infections due to susceptible Gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii, has not been generally questioned. However, their use was abandoned, except in patients with cystic fibrosis, because of concerns related to toxicity. METHODS: We reviewed old and recent evidence regarding polymyxin-induced toxicity by searching Pubmed (from 1950 until May 2005). RESULTS: It was reported in the old literature that the use of polymyxins was associated with considerable toxicity, mainly nephrotoxicity and neurotoxicity, including neuromuscular blockade. However, recent studies showed that the incidence of nephrotoxicity is less common and severe compared to the old studies. In addition, neurotoxic effects of polymyxins are usually mild and resolve after prompt discontinuation of the antibiotics. Furthermore, cases of neuromuscular blockade and apnea have not been reported in the recent literature. CONCLUSION: New evidence shows that polymyxins have less toxicity than previously reported. The avoidance of concurrent administration of nephrotoxic and/or neurotoxic drugs, careful dosing, as well as more meticulous management of fluid and electrolyte abnormalities and use of critical care services may be some of the reasons for the discrepancy between data reported in the old and recent literature.
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spelling pubmed-15508022006-08-22 Toxicity of polymyxins: a systematic review of the evidence from old and recent studies Falagas, Matthew E Kasiakou, Sofia K Crit Care Research BACKGROUND: The increasing problem of multidrug-resistant Gram-negative bacteria causing severe infections and the shortage of new antibiotics to combat them has led to the re-evaluation of polymyxins. These antibiotics were discovered from different species of Bacillus polymyxa in 1947; only two of them, polymyxin B and E (colistin), have been used in clinical practice. Their effectiveness in the treatment of infections due to susceptible Gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii, has not been generally questioned. However, their use was abandoned, except in patients with cystic fibrosis, because of concerns related to toxicity. METHODS: We reviewed old and recent evidence regarding polymyxin-induced toxicity by searching Pubmed (from 1950 until May 2005). RESULTS: It was reported in the old literature that the use of polymyxins was associated with considerable toxicity, mainly nephrotoxicity and neurotoxicity, including neuromuscular blockade. However, recent studies showed that the incidence of nephrotoxicity is less common and severe compared to the old studies. In addition, neurotoxic effects of polymyxins are usually mild and resolve after prompt discontinuation of the antibiotics. Furthermore, cases of neuromuscular blockade and apnea have not been reported in the recent literature. CONCLUSION: New evidence shows that polymyxins have less toxicity than previously reported. The avoidance of concurrent administration of nephrotoxic and/or neurotoxic drugs, careful dosing, as well as more meticulous management of fluid and electrolyte abnormalities and use of critical care services may be some of the reasons for the discrepancy between data reported in the old and recent literature. BioMed Central 2006 2006-02-13 /pmc/articles/PMC1550802/ /pubmed/16507149 http://dx.doi.org/10.1186/cc3995 Text en Copyright © 2006 Falagas and Kasiakou; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Falagas, Matthew E
Kasiakou, Sofia K
Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
title Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
title_full Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
title_fullStr Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
title_full_unstemmed Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
title_short Toxicity of polymyxins: a systematic review of the evidence from old and recent studies
title_sort toxicity of polymyxins: a systematic review of the evidence from old and recent studies
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550802/
https://www.ncbi.nlm.nih.gov/pubmed/16507149
http://dx.doi.org/10.1186/cc3995
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