Neurotoxicity and Nephrotoxicity
Colistin is an antibiotic which is being used more commonly now than when it was introduced because of its activity against multiresistant Gram-negative bacteria, especially Acinetobacter baumanii and Enterobacteriaceae producing extended spectrum β-lactamases. It had a bad reputation due to reports of neurotoxicity and nephrotoxicity. Recent studies have shown lower rates of nephrotoxicity than previously reported. However, in one of these reports, 7/42 patients with high serum creatinine values prior to colistin treatment developed renal failure.
Polymyxin E (colistin) is a complex of closely related cyclic peptides E1 and E2, with additional minor analogues. Polymyxin E is produced by Bacillus polymyxa var. colistinus, and is a highly basic, atypical cyclic peptide which incorporates the unusual amino acid, diaminobutyric acid. Head-to-tail coupling of lysine completes the macrocycle. Balancing the polar cyclic peptide is a hydrophobic tail with short chain fatty acids. Polymyxin E is a broad spectrum antibiotic active against Gram negative bacteria. The mechanism of action involves disruption of the bacterial outer membrane by a detergent-like effect.
