Dr. Grey AI

Colistin (Polymyxin E)

Peptide

Colistin is a cyclic lipopeptide antibiotic (polymyxin E) discovered 1947, FDA-approved 1959. Administered as inactive prodrug colistimethate sodium (CMS) for parenteral use. WHO Essential Medicine and critically important for human medicine. Last-resort therapy for MDR gram-negative infections. Meta-analysis of 5 RCTs (n=377): 36% nephrotoxicity incidence vs 15% comparators (NNH=5). Pediatric review (17 studies, n=312): Effective for BSI, pneumonia, meningitis in neonates. SAFETY CONCERN: Dose-dependent nephrotoxicity (40-45% incidence); neurotoxicity reported; 75% AKI recovery upon discontinuation.

Quick Answer

What it is

Colistin is a cyclic lipopeptide antibiotic (polymyxin E) discovered 1947, FDA-approved 1959. Administered as inactive prodrug colistimethate sodium (CMS) for parenteral use.

Key findings

  • Grade A: MDR Gram-Negative Infections (Multidrug-Resistant Bacterial Infections)
  • Grade A: Ventilator-Associated Pneumonia (Multidrug-Resistant Bacterial Infections)
  • Grade A: Nephrotoxicity Incidence (Multidrug-Resistant Bacterial Infections)

Safety

No specific caution or interaction language was detected in the current summary/outcome notes.

⚠️ Research Notice

This peptide information is for educational and research purposes only. Peptides may not be FDA-approved for human use and may only be legally available for research purposes. Consult qualified healthcare professionals before considering any peptide compounds.

ℹ️ Quick Facts: Colistin (Polymyxin E)

Quick Facts: Colistin (Polymyxin E)

  • Best Evidence:Grade A
  • Conditions Studied:1
  • Research Outcomes:9
  • Grade A Findings:3
  • Grade B Findings:3
  • Key Effect:Multidrug-Resistant Bacterial Infections
A3
B3
C3
D0
1 conditions · 9 outcomes

Detailed Outcomes

A
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.
moderate↑Improves
A
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.
moderate↑Improves
A
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.
large↑Worsens
B
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.
moderate↑Improves
B
Neurotoxicity Risk
SAFETY CONCERN: Neurotoxicity reported including paresthesias, ataxia, neuromuscular blockade. Appears reversible upon discontinuation or dose reduction. Less common than nephrotoxicity.
small↑Worsens
B
Kidney Function
8 human trials and systematic reviews support this finding. Evidence includes systematic reviews/meta-analyses. Human clinical trial data available.
moderate↑Improves
C
Antimicrobial Activity
16 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.
moderate↑Improves
C
Safety/Tolerability
15 systematic reviews and preclinical studies support this finding. Evidence includes systematic reviews/meta-analyses. Primarily preclinical evidence.
moderate↑Improves
C
Liver Protection
3 human trials support this finding. Human clinical trial data available.
small↑Improves

Related Peptides

Polymyxin B

Peptide

1 shared condition · 10 outcomes

Polymyxin B is a cyclic lipopeptide antibiotic discovered in the 1940s from Paenibacillus polymyxa. Re-established as last-resort therapy for MDR/XDR gram-negative infections including carbapenem-resistant Enterobacteriaceae (CRE), MDR Pseudomonas aeruginosa, and MDR Acinetobacter baumannii. Multicenter studies (n=312): 70.5% 14-day survival for CRGNB infections. Less nephrotoxic than colistin. Non-renal elimination allows use without dose adjustment for renal impairment. SAFETY CONCERN: Dose-limiting nephrotoxicity (35-60% AKI incidence); narrow therapeutic window.