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Colistin and polymyxin B: peas in a pod, or chalk and cheese?

Roger L Nation1, Tony Velkov1, Jian Li1

  • 1Drug Delivery, Disposition, and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|April 5, 2014
PubMed

Insights

Polymyxin B offers better clinical and pharmacological properties than colistin methanesulfonate (CMS)/colistin. Further studies are needed to compare their efficacy and safety in treating infections.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Colistin and polymyxin B exhibit similar in vitro antimicrobial activity.
  • Parenteral administration differs: polymyxin B is active, while colistin is a prodrug (colistin methanesulfonate, CMS).
  • CMS requires in vivo conversion to active colistin, which is slow and incomplete.

Purpose of the Study:

  • To summarize key differences between parenteral CMS/colistin and polymyxin B.
  • To highlight the clinical implications of these differences.
  • To propose comparative studies on efficacy and safety.

Main Methods:

  • Review and comparison of pharmacological properties.
  • Analysis of clinical administration routes and in vivo conversion.
  • Literature synthesis on existing data.

Main Results:

  • Polymyxin B is administered as the active drug, whereas CMS is an inactive prodrug requiring conversion.
  • The conversion of CMS to colistin in vivo is inefficient.
  • Polymyxin B demonstrates superior clinical pharmacological properties compared to CMS/colistin.

Conclusions:

  • Polymyxin B appears to have advantages over CMS/colistin in parenteral administration.
  • Prospective studies are recommended in the US to compare the efficacy and safety of both agents.
  • Clinicians should carefully weigh the benefits of each polymyxin based on the clinical scenario.
Keywords:
colistindiffering clinical pharmacological behaviorspolymyxin Btherapeutic implications

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