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Expert Rev Anti Infect Ther. 2015;13(12):1481-97. doi: 10.1586/14787210.2015.1093933. Epub 2015 Oct 21.

Polymyxin B versus colistin: an update.

Cai Y1,2, Lee W1, Kwa AL1,3,2.

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a 1 Department of Pharmacy, Singapore General Hospital, Outram Rd 169608, Singapore.
c 3 Department of Pharmacy, National University of Singapore, 21 Lower Kent Ridge Rd 119077, Singapore.
b 2 Emerging Infectious Diseases, Duke-NUS Graduate Medical School, 8 College Rd 169857, Singapore.


Polymyxin B and colistin (polymyxin E) are polypeptide antibiotics that were developed in the 1940s, but fell into disfavor due to their high toxicity rates. These two antibiotics were previously regarded to be largely equivalent, due to similarities in their chemical structure and spectrum of activity. In recent years, several pertinent differences, especially in terms of potency and disposition, have been revealed between polymyxin B and colistin. These differences are mainly attributed to the fact that polymyxin B is administered parenterally in its active form, while colistin is administered parenterally as an inactive pro-drug, colistimethate. In this review, we summarize the similarities and differences between polymyxin B and colistin. We also discuss the potential clinical implications of these findings, and provide our perspectives on how polymyxins should be employed to preserve their utility in this era of multi-drug resistance.


colistimethate sodium; colistin sulfate; multi-drug resistance; pharmacokinetics and pharmacodynamics; polymyxin B; polymyxin combination therapy; polymyxins; polypeptide antibiotics

[Indexed for MEDLINE]

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