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  • A 62-year-old woman presents to the emergency room with fevers, abdominal pain, and frequent urination. She has a past medical history of diabetes mellitus, chronic obstructive pulmonary disease, and frequent urinary tract infections. On physical exam, there is suprapubic tenderness and right-sided costovertebral angle tenderness. Urine culture reveals multidrug-resistant Pseudomonas aeruginosa, sensitive only to polymyxins.
  • Drugs
    • polymyxin B
    • polymyxin E (colistin)
  • Mechanism of action
    • these drugs are cation polypeptides that bind to cell membrane phospholipids that disrupt the cell membrane causing leakage of cell contents
  • Clinical use
    • used as a last-resort therapy for multidrug-resistant gram-negative organisms
    • multidrug-resistant Pseudomonas aeruginosa
    • multidrug-resistant Actinobacter baumannii
    • also used for superficial skin infections as a topical ointment
  • Adverse effects
    • nephrotoxicity
    • neurotoxicity
    • respiratory tract paralysis and failure
    • gastrointestinal upset (C. difficile diarrhea)
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