The
polymyxin antibiotics colistin (
polymyxin E) and
polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as
salvage therapy for otherwise untreatable gram-negative
infections. Since their reintroduction into the clinic, significant
confusion remains due to the existence of several different conventions used to describe doses of the
polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose
colistin and
polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the
polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP),
Infectious Diseases Society of America (IDSA), International Society of Anti-Infective Pharmacology (ISAP), Society for
Critical Care Medicine (SCCM), and Society of
Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and
Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets,
polymyxin agent selection, dosing, dosage adjustment and monitoring of
colistin and
polymyxin B, use of
polymyxin-based combination
therapy, intrathecal
therapy, inhalation therapy, toxicity, and prevention of
renal failure. The treatment guidelines provide the first ever consensus recommendations for
colistin and
polymyxin B therapy that are intended to guide optimal clinical use.