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Multidrug-Resistant Bacterial Infections

Multidrug-resistant infections arise when bacteria adapt to withstand several common antibiotics, leaving fewer medicines that work. Colistin and polymyxin B, older last-resort antibiotics, have the strongest evidence: pooled trials found colistin useful against resistant Gram-negative bacteria, and about 70% of people given polymyxin B in one study were alive after 14 days. The colistin trials were few and small, and the polymyxin B work was observational.

Sources: PMID 25199968; PMID 40047414

Supplements studied
0
Medicines and peptides
2
Graded outcomes
10
No supplement studies yetWe haven’t found supplement studies for Multidrug-Resistant Bacterial Infections. The medicines and peptides studied for it are listed below.

Prescription medicines and peptides studied, for context

These are not supplements. Most need a prescription, and some are research compounds with no approved use.

2 medicines and peptides

Colistin (Polymyxin E)

Colistin (Polymyxin E): outcomes studied for Multidrug-Resistant Bacterial Infections
GradeOutcomeEffectSizeStudiesPeopleStudies list
MDR Gram-Negative Infections

Meta-analysis of 5 RCTs (n=377): Effective last-resort option for MDR infections. Cochrane reviews support use for pneumonia, BSI. Clinical success 59.5% in PK study. WHO Essential Medicine designation.

Improves (the measure goes up)Moderate effect16 studies

Studies that measured mdr gram-negative infections

and 13 more on the Colistin (Polymyxin E) page

Ventilator-Associated Pneumonia

Most common indication in RCTs. Nebulized colistin shows similar efficacy to IV with potentially less nephrotoxicity. Clinical cure rates comparable to β-lactam regimens.

Improves (the measure goes up)Moderate effect15 studies

Studies that measured ventilator-associated pneumonia

and 12 more on the Colistin (Polymyxin E) page

Nephrotoxicity Incidence

SAFETY CONCERN: Meta-analysis: 36.2% nephrotoxicity vs 15% comparators (RR 2.40, NNH=5). Comprehensive study (n=178): 44.9% incidence. Median onset 4-6 days. 75% recovery within 10 days of discontinuation. Reversible tubular damage.

Worsens (the measure goes up)Large effect14 studies

Studies that measured nephrotoxicity incidence

and 11 more on the Colistin (Polymyxin E) page

Pediatric/Neonatal Infections

Systematic review (17 studies, n=312 neonates/infants): Effective for BSI, pneumonia, meningitis. Doses 25,000-225,000 IU/kg/day. PK studies suggest >150,000 IU/kg/day needed. Limited nephrotoxicity data in children.

Improves (the measure goes up)Moderate effect15 studies

Studies that measured pediatric/neonatal infections

and 12 more on the Colistin (Polymyxin E) page

Neurotoxicity Risk

SAFETY CONCERN: Neurotoxicity reported including paresthesias, ataxia, neuromuscular blockade. Appears reversible upon discontinuation or dose reduction. Less common than nephrotoxicity.

Worsens (the measure goes up)Small effect15 studies

Studies that measured neurotoxicity risk

and 12 more on the Colistin (Polymyxin E) page

Polymyxin B

Polymyxin B: outcomes studied for Multidrug-Resistant Bacterial Infections
GradeOutcomeEffectSizeStudiesPeopleStudies list
Carbapenem-Resistant GNB Infections

Prospective multicenter study (n=312): 14-day survival 70.5% for CRGNB infections. Site-specific outcomes: LRTI 67.7%, IAI 80.3%, BSI 69.7% survival. Last-resort efficacy against otherwise untreatable MDR pathogens.

Improves (the measure goes up)Moderate effect12 studies

Studies that measured carbapenem-resistant gnb infections

and 9 more on the Polymyxin B page

Nephrotoxicity Risk

SAFETY CONCERN: AKI incidence 35-60% across studies. Risk factors: duration of use, BMI, advanced age, concomitant nephrotoxins. Generally reversible upon discontinuation. Possibly milder than colistin-associated nephrotoxicity.

Worsens (the measure goes up)Moderate effect9 studies

Studies that measured nephrotoxicity risk

and 6 more on the Polymyxin B page

MDR Pseudomonas aeruginosa

Rapid bactericidal activity against MDR P. aeruginosa with low acquired resistance rates. MIC90 generally 1-2 mg/L. Essential option when all other antipseudomonal agents have failed.

Improves (the measure goes up)Moderate effect7 studies

Studies that measured mdr pseudomonas aeruginosa

and 4 more on the Polymyxin B page

MDR Acinetobacter baumannii

Retained activity against extensively drug-resistant A. baumannii. Organism cleared in 88% of patients in clinical studies. Critical therapy for nosocomial Acinetobacter infections.

Improves (the measure goes up)Moderate effect7 studies

Studies that measured mdr acinetobacter baumannii

and 4 more on the Polymyxin B page

Pediatric Efficacy

Population PK study (n=19 pediatric patients): Clinical success 73.7% with only 5.3% AKI rate. Weight-based dosing (1.33-2.53 mg/kg/day). Lower nephrotoxicity risk in pediatric population.

Improves (the measure goes up)Moderate effect7 studies

Studies that measured pediatric efficacy

and 4 more on the Polymyxin B page

Key findings

  • MDR Gram-Negative InfectionsColistin (Polymyxin E)Improves (the measure goes up)
  • Ventilator-Associated PneumoniaColistin (Polymyxin E)Improves (the measure goes up)
  • Nephrotoxicity IncidenceColistin (Polymyxin E)Worsens (the measure goes up)

Safety notes in the studies

  • Risk factors: duration of use, BMI, advanced age, concomitant nephrotoxins.
  • Lower nephrotoxicity risk in pediatric population.

Studies cited

33 studies from PubMed

  1. Novel strategies for combating colistin-resistant isolates: a review.Archives of microbiology, 2025 · PMID 41134327
  2. Prevalence of colistin resistance in clinical Klebsiella pneumoniae isolates: a systematic review and meta-analysis.Future microbiology, 2025 · PMID 40619750
  3. Prevention of colistin-induced neurotoxicity: a narrative review of preclinical data.Naunyn-Schmiedeberg's archives of pharmacology, 2024 · PMID 38091077
  4. Clinical outcomes and pharmacokinetics/pharmacodynamics of intravenous polymyxin B treatment for various site carbapenem-resistant gram-negative bacterial infections: a prospective observational multicenter studyAntimicrob Agents Chemother, 2024 · PMID 40047414
  5. Molecular mechanisms and clonal lineages of colistin-resistant bacteria across the African continent: a scoping review.Letters in applied microbiology, 2022 · PMID 36000241
  6. Prevalence of colistin resistance of Klebsiella pneumoniae isolates in Iran: a systematic review and meta-analysis.Annals of clinical microbiology and antimicrobials, 2022 · PMID 35765073
  7. Global colistin use: a review of the emergence of resistant Enterobacterales and the impact on their genetic basis.FEMS microbiology reviews, 2022 · PMID 34612488
  8. Population pharmacokinetics and clinical outcomes of polymyxin B in paediatric patients with multidrug-resistant Gram-negative bacterial infectionsJ Antimicrob Chemother, 2022 · PMID 35924405
  9. Effectiveness, nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patientsAnn Pharmacother, 2022 · PMID 35586931
  10. Population Pharmacokinetics of Colistin Sulfate in Critically Ill Patients: Exposure and Clinical EfficacyAntimicrob Agents Chemother, 2022 · PMID 35784679
  11. Mobilized colistin resistance (mcr) genes from 1 to 10: a comprehensive review.Molecular biology reports, 2021 · PMID 33839987
  12. Clinical outcomes and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacterial infections: a real-world multicenter studyFront Pharmacol, 2021 · PMID 34656132
  13. Colistin heteroresistance in Acinetobacter spp.: systematic review and meta-analysis of the prevalence and discussion of the mechanisms and potential therapeutic implications.International journal of antimicrobial agents, 2020 · PMID 32599229
  14. Colistin and its role in the Era of antibiotic resistance: an extended review (2000-2019).Emerging microbes & infections, 2020 · PMID 32284036
  15. Polymyxin B clinical outcomes: A prospective study of patients undergoing intravenous treatmentJ Glob Antimicrob Resist, 2019 · PMID 30666679
  16. The Use of Colistin for the Treatment of Multidrug-resistant Gram-negative Infections in Neonates and Infants: A Review of the LiteraturePediatr Infect Dis J, 2019 · PMID 31469781
  17. Rational use of intravenous polymyxin B and colistin: A review.The Medical journal of Malaysia, 2018 · PMID 30350826
  18. Population Pharmacokinetics of Polymyxin BClin Microbiol Infect, 2018 · PMID 29238962
  19. Pharmacokinetics/pharmacodynamics of colistin and polymyxin B: are we there yet?Int J Antimicrob Agents, 2016 · PMID 27793510
  20. A review on colistin nephrotoxicityEur J Clin Pharmacol, 2015 · PMID 26008213
  21. Colistin: understanding and applying recent pharmacokinetic advancesClin Microbiol Infect, 2015 · PMID 25187500
  22. Colistin for the treatment of ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: a systematic review and meta-analysis.International journal of antimicrobial agents, 2014 · PMID 25199968
  23. Systematic review of the evidence for rational dosing of colistin.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2014 · PMID 24897820
  24. Population pharmacokinetics of intravenous polymyxin B in critically ill patients: implications for selection of dosage regimensClin Infect Dis, 2013 · PMID 23697744
  25. Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosingInt J Antimicrob Agents, 2010 · PMID 21114395
  26. Multidrug-resistant Gram-negative infections: the use of colistinExpert Rev Anti Infect Ther, 2008 · PMID 20818945
  27. Polymyxin B for the treatment of multidrug-resistant pathogens: a critical reviewClin Infect Dis, 2007 · PMID 17878146
  28. Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infectionsLancet Infect Dis, 2006 · PMID 16931410
  29. Polymyxin B nephrotoxicity and efficacy against nosocomial infections caused by multiresistant gram-negative bacteriaAntimicrob Agents Chemother, 2003 · PMID 12878536
  30. Polymyxin B sulfate and colistin: old antibiotics for emerging multiresistant gram-negative bacteriaAnn Pharmacother, 1999 · PMID 10492501
  31. Efficacy and safety of Kegan Liyan oral liquid for patients with acute pharyngitis: A randomized, double-blinded, placebo-controlled, multi-center trial.Phytomedicine · PMID 39217655
  32. Comparative Efficacy of 6 Topical Pharmacological Agents for Preventive Interventions of Postoperative Sore Throat After Tracheal Intubation: A Systematic Review and Network Meta-analysis.Anesth Analg · PMID 33886521
  33. [Do colostrum tablets have a symptomatic effect on sore throat?]Tidsskr Nor Laegeforen · PMID 15608761