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The Use of Intravenous and Aerosolized Polymyxins for the Treatment of Infections in Critically Ill Patients: A Review of the Recent Literature

Matthew E. Falagas, MD; Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Medicine, Henry Dunant Hospital, Athens, Greece; and Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
Sofia K. Kasiakou, MD; Alfa Institute of Biomedical Sciences, Athens, Greece
Sotirios Tsiodras, MD; Department of Medicine, Attikon General University Hospital, University of Athens School of Medicine, Athens, Greece
Argyris Michalopoulos, MD; Intensive Care Unit, Henry Dunant Hospital, Athens, Greece

Reprint Requests: Matthew E. Falagas, MD, MSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, Marousi 151 23, Greece,Tel: 30 694 61 10 000; Fax: 30 210 68 39 605, E-mail: matthew.falagas{at}tufts.edu

Intravenous and aerosolized polymyxins are being used increasingly, especially in the critical care setting, for treating patients with infections due to multidrug-resistant Gram-negative bacteria, mainly Acinetobacter baumannii and Pseudomonas aeruginosa. Recent literature suggests that intravenous colistin and polymyxin B have acceptable effectiveness for the treatment of patients with bacteremia, as well as infections of various systems and organs, including pneumonia, bacteremia, skin and soft tissue, and urinary tract infections. Although data from recent studies have suggested that the toxicity of intravenous polymyxins is probably less than reported in the older literature, caution should be taken to monitor the renal function of patients who receive these antibiotics.

Key Words: Acinetobacter • Colistin • Inhalation • Intensive care unit • Klebsiella • Multidrug-resistant Gram-negative bacteria • Nebulization • Pneumonia • Polymyxin B • Pseudomonas • Ventilator-associated

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