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Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
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Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections with Polymyxins: A Review

Xiangquan Li1, Weiwei Chong2, Jing Mo3

  • 1Department of Critical Care Medicine, Xuzhou Central Hospital, Southeast University Affiliated Xuzhou Central Hospital, Xuzhou, Jiangsu, 221009, People's Republic of China.

Infection and Drug Resistance
|December 10, 2025
PubMed

Insights

Polymyxins, like polymyxin B and E, are vital antibiotics against resistant gram-negative bacteria. While effective, they offer no survival benefit over other antibiotics and carry risks of kidney and nerve damage.

Area of Science:

  • Pharmacology and Microbiology
  • Infectious Diseases

Background:

  • Antimicrobial resistance is a global health crisis.
  • Polymyxins (polymyxin B and E) are critical antibiotics for treating multidrug-resistant Gram-negative infections.

Purpose of the Study:

  • To review the efficacy and safety of polymyxins.
  • To evaluate polymyxin combination therapy versus monotherapy.

Main Methods:

  • Literature review of polymyxin mechanisms, clinical use, and comparative efficacy.
  • Analysis of evidence regarding combination therapy and adverse events.

Main Results:

  • Polymyxins disrupt bacterial membranes and neutralize endotoxins.
  • No significant efficacy difference exists between polymyxin B and E.
  • Combination therapy is not demonstrably superior to monotherapy.
  • Intravenous and nebulized administration may enhance microbial clearance.

Conclusions:

  • Polymyxins are effective against carbapenem-resistant gram-negative bacteria but lack survival benefit compared to other antibiotics.
  • Nephrotoxicity and neurotoxicity are significant concerns requiring careful monitoring.
  • Further research into optimizing polymyxin use is warranted.
Keywords:
bloodstream infectionscarbapenem-resistant gram-negative bacteriahospital-acquired pneumoniamortalitypolymyxins

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