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Colistin, also known as polymyxin E, is an antibiotic medication used as a last-resort treatment for multidrug-resistant Gram-negative infections including pneumonia. [ 7 ] [ 8 ] These may involve bacteria such as Pseudomonas aeruginosa , Klebsiella pneumoniae , or Acinetobacter . [ 9 ]
Polymyxin antibiotics are relatively neurotoxic and nephrotoxic, so are usually used only as a last resort if modern antibiotics are ineffective or are contraindicated. Typical uses are for infections caused by strains of multiple drug-resistant Pseudomonas aeruginosa or carbapenemase-producing Enterobacteriaceae.
Infections caused by Gram-negative bacteria, such as Escherichia coli and Klebsiella particularly Pseudomonas aeruginosa. Effective against aerobic bacteria (not obligate/facultative anaerobes) and tularemia. All aminoglycosides are ineffective when taken orally as the stomach will digest the drug before it goes into the bloodstream.
Since 1993, some strains of E. coli have become resistant to multiple types of fluoroquinolone antibiotics. [citation needed] E. coli was identified as one of the six leading pathogens for deaths associated with resistance in 2019 and that year there were 829,000 deaths globally of people with drug-resistant infection from the pathogen. [26]
Some drugs need to be used with caution in patients with renal dysfunction. The use of nitrofurantoin is contraindicated in patients with an estimated GFR of less than 30 mL/min/1.73m 2 as drug accumulation can lead to increased side effects and impaired recovery of the urinary tract, increasing the risk of treatment failure. [29]
Mecillinam or amdinocillin is an extended-spectrum penicillin antibiotic of the amidinopenicillin class that binds specifically to penicillin binding protein 2 (PBP2), [2] and is only considered to be active against Gram-negative bacteria.
Cefixime is a broad spectrum cephalosporin antibiotic and is commonly used to treat bacterial infections of the ear, urinary tract, and upper respiratory tract. The following represents MIC susceptibility data for a few medically significant microorganisms: [15] Escherichia coli: 0.015 μg/mL – 4 μg/mL
Rifampicin can be used as monotherapy for a few days as prophylaxis against meningitis, but resistance develops quickly during long-term treatment of active infections, so the drug is always used against active infections in combination with other antibiotics.