Understanding the Harmful Impact of Polymyxins on Acinetobacter baumannii

Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) have become a global concern. The extensive antibiotic resistance of CRAB has significantly limited treatment options, while its prevalence in hospital outbreaks has amplified infection rates. This scenario has led to a resurgence of interest in polymyxins, an older class of antibiotics previously overlooked due to perceived toxicity. Polymyxins, cationic polypeptide antibiotics, now represent a last-resort treatment option. Despite their historical use, modern assessment methods have only recently been applied to evaluate polymyxins. Two polymyxins are available for clinical use: polymyxin B and colistin (polymyxin E). Notably, the administration of these drugs is hindered by toxicities, primarily nephrotoxicity and neurotoxicity, alongside less common adverse effects such as injection pain, hypersensitivity reactions, and bronchospasms.