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Clinical Microbiology Reviews, July 2008, p. 449-465, Vol. 21, No. 3
0893-8512/08/$08.00+0     doi:10.1128/CMR.00006-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Polymyxins Revisited

David Landman, Claudiu Georgescu, Don Antonio Martin, and John Quale*

Division of Infectious Diseases, SUNY-Downstate Medical Center, Brooklyn, New York

The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.

* Corresponding author. Mailing address: Division of Infectious Diseases, Box 77, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203. Phone: (718) 270-2148. Fax: (718) 270-2465. E-mail: jquale{at}downstate.edu

Clinical Microbiology Reviews, July 2008, p. 449-465, Vol. 21, No. 3
0893-8512/08/$08.00+0     doi:10.1128/CMR.00006-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Choi, S.-K., Park, S.-Y., Kim, R., Kim, S.-B., Lee, C.-H., Kim, J. F., Park, S.-H. (2009). Identification of a Polymyxin Synthetase Gene Cluster of Paenibacillus polymyxa and Heterologous Expression of the Gene in Bacillus subtilis. J. Bacteriol. 191: 3350-3358 [Abstract] [Full Text]  
  • Livermore, D. M., Tulkens, P. M. (2009). Temocillin revived. J Antimicrob Chemother 63: 243-245 [Abstract] [Full Text]  


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