Polymyxin toxicity remains a significant concern that limits the clinical utility of this class of antibacterials for patient care. The most notable adverse event is the dose- and treatment-limiting nephrotoxicity that occurs in roughly 30-60% of patients receiving a systemic polymyxin. This chapter focuses on this adverse event with a detailed assessment of the incidence of, and risk factors for, polymyxin-associated nephrotoxicity. In particular, the text focuses on the impact of dose, serum concentrations, and polymyxin selection on nephrotoxicity. Additionally, less common, but clinically important adverse events are discussed.
Keywords: Colistimethate; Colistin; Gram-negative bacteria; Nephrotoxicity; Non-renal toxicities; Polymyxin B.