Polymyxins: Pharmacology, pharmacokinetics, pharmacodynamics, and clinical applications

The development of increasing drug resistance within the past two decades has caused increased interest in re-evaluating the polymyxin antibiotics as therapeutic options for the treatment of multidrug resistant gram-negative infections. Polymyxins were largely abandoned because of toxicity concerns with the class. Little pharmacokinetic and pharmacodynamic data exist for these antibiotics, however, possibly leading to inappropriate dosing regimens. Susceptibility testing and toxicity of the polymyxins are additional areas of discrepancy This article presents an overview of the many issues concerning the polymyxins.