Colistin - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-01-25T16:38:05Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 16:38, 25 January 2022
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	*Intrinsic resistance in:		*Intrinsic resistance in:
	**All [[Gram-positive bacteria]], which lack the lipopolysaccharide target		**All [[Gram-positive bacteria]], which lack the lipopolysaccharide target
	**[[Enterobacterales]]: [[Morganellaceae]] ([[Proteus ~~species~~]], [[Morganella morganii]], [[Providencia ~~species~~]]), and [[Serratia marcescens]]		**[[Enterobacterales]]: [[Morganellaceae]] ([[Proteus]], [[Morganella morganii]], [[Providencia]]), and [[Serratia marcescens]]
	**Afermentative Gram-negative bacteria: [[Burkholderia ~~species~~]]		**Afermentative Gram-negative bacteria: [[Burkholderia]]
	**Other notable bacteria: [[Neisseria ~~species~~]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], [[Chromobacterium ~~species~~]], [[Brucella ~~species~~]], [[Inquilinus ~~species~~]], [[Pandoraea]]		**Other notable bacteria: [[Neisseria]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], [[Chromobacterium]], [[Brucella]], [[Inquilinus]], [[Pandoraea]]

	===Pharmacokinetics and Pharmacodynamics===		===Pharmacokinetics and Pharmacodynamics===

Aidan at 13:26, 3 February 2021

2021-02-03T13:26:12Z

← Older revision		Revision as of 13:26, 3 February 2021
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	*Concentration-dependent activity		*Concentration-dependent activity

			=== Clinical Breakpoints ===
			{\| class="wikitable"
			! rowspan="2" \|Species
			! rowspan="2" \|ECV (μg/mL)
			! colspan="4" \|Breakpoints (μg/mL)
			! colspan="4" \|Breakpoints (mm)
			\|-
			!S
			!SDD
			!I
			!R
			!S
			!SDD
			!I
			!R
			\|-
			\|[[Acinetobacter baumannii complex]]
			\|
			\|—
			\|—
			\|≤2
			\|≥4
			\|
			\|
			\|
			\|
			\|}
	==Dosing==		==Dosing==

Aidan: /* Dosing Equivalents */

2020-10-17T12:17:12Z

Dosing Equivalents

← Older revision		Revision as of 12:17, 17 October 2020
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	*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)		*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
	**1 MIU = 80 mg colistimethate (CMS) in Europe		**1 MIU = 80 mg colistimethate (CMS) in Europe = 30 mg colistin base activity (CBA) in the US
	**1 MIU = 30 mg colistin base activity (CBA) in the US
	**1 mg of CMS = 0.375 mg of colistin base activity = 12,500 IU		**1 mg of CMS = 0.375 mg of colistin base activity = 12,500 IU
	**1 mg of colistin base activity = 2.6 mg of CMS = 32,500 IU		**1 mg of colistin base activity = 2.6 mg of CMS = 32,500 IU

Aidan at 12:57, 20 September 2020

2020-09-20T12:57:51Z

← Older revision		Revision as of 12:57, 20 September 2020
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	*Broadly active against [[Gram-negative bacteria]], including [[Enterobacterales]] and [[afermentative Gram-negative bacilli]]		*Broadly active against [[Gram-negative bacteria]], including [[Enterobacterales]] and [[afermentative Gram-negative bacilli]]
			*Intrinsic resistance in:
	*Not active against [[Gram-positive bacteria]], given that they don't have lipopolysaccharide
			**All [[Gram-positive bacteria]], which lack the lipopolysaccharide target
⚫	*~~Intrinsic~~ ~~resistance~~ in [[Neisseria species]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], ~~[[Proteus species]], [[Serratia marcescens]], [[Morganella morganii]], [[Providencia species]],~~ [[Chromobacterium species]], [[Brucella species]], [[Inquilinus species]], [[Pandoraea~~]], and [[Burkholderia species~~]]
			**[[Enterobacterales]]: [[Morganellaceae]] ([[Proteus species]], [[Morganella morganii]], [[Providencia species]]), and [[Serratia marcescens]]
			**Afermentative Gram-negative bacteria: [[Burkholderia species]]
		⚫	**Other notable bacteria: [[Neisseria species]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], [[Chromobacterium species]], [[Brucella species]], [[Inquilinus species]], [[Pandoraea]]

	===Pharmacokinetics and Pharmacodynamics===		===Pharmacokinetics and Pharmacodynamics===
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	==Dosing==		==Dosing==

	=== Dosing Equivalents ===		===Dosing Equivalents===

	* Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)		*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
	**1 MIU = 80 mg colistimethate (CMS) in Europe		**1 MIU = 80 mg colistimethate (CMS) in Europe
	**1 MIU = 30 mg colistin base activity (CBA) in the US		**1 MIU = 30 mg colistin base activity (CBA) in the US
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	*Exists.		*Exists.

	=== Inhalational Dosing ===		===Inhalational Dosing===

	* CMS is dissolved in 4–6 ml of normal saline or sterile water and given by nebulizer		*CMS is dissolved in 4–6 ml of normal saline or sterile water and given by nebulizer
	** Results in low systemic levels		**Results in low systemic levels
	* Body weight <40 kg: 0.5 MIU (40 mg) of CMS every 12 h		*Body weight <40 kg: 0.5 MIU (40 mg) of CMS every 12 h
	* Body weight >40 kg: 1.0 MIU (80 mg) of CMS every 12 h		*Body weight >40 kg: 1.0 MIU (80 mg) of CMS every 12 h
	* For recurrent or severe pulmonary infection: 2.0 MIU (160 mg) of CMS every 8 h		*For recurrent or severe pulmonary infection: 2.0 MIU (160 mg) of CMS every 8 h

	=== Renal Dosing ===		===Renal Dosing===

	* Serum creatinine level 115 to 132 μmol/L: 2 MIU (160 mg) of CMS every 8 h		*Serum creatinine level 115 to 132 μmol/L: 2 MIU (160 mg) of CMS every 8 h
	* Serum creatinine level 141 to 221 μmol/L: 2 MIU (160 mg) of CMS every 12 h		*Serum creatinine level 141 to 221 μmol/L: 2 MIU (160 mg) of CMS every 12 h
	* Serum creatinine level ≥230 μmol/L: 2 MIU (160 mg) of CMS every 24 h		*Serum creatinine level ≥230 μmol/L: 2 MIU (160 mg) of CMS every 24 h
	* Hemodialysis: 2 MIU (160 mg) of CMS after each hemodialysis		*Hemodialysis: 2 MIU (160 mg) of CMS after each hemodialysis
	* Peritoneal dialysis: 2 MIU (160 mg) of CMS daily during peritoneal dialysis		*Peritoneal dialysis: 2 MIU (160 mg) of CMS daily during peritoneal dialysis
	* Continuous renal replacement therapy (CRRT): high loading dose followed by a maintenance dose of up to 4.5 MIU every 8 h		*Continuous renal replacement therapy (CRRT): high loading dose followed by a maintenance dose of up to 4.5 MIU every 8 h
	** Continuously eliminated, and needs higher dosing		**Continuously eliminated, and needs higher dosing

	==Safety==		==Safety==

Aidan at 12:21, 13 September 2020

2020-09-13T12:21:27Z

← Older revision		Revision as of 12:21, 13 September 2020
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	==Background==		==Background==

	*A member of the polymyxin class also known as polymyxin E		*A member of the [[Polymyxins\|polymyxin]] class also known as '''polymyxin E'''
			*Administered intravenously as a prodrug, colistin methanesulphonate (CMS), or orally and topically as colistin sulfate
	*Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)
			*Active against most Gram-negative bacteria
	*Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant ~~Enterobacteriaceae~~		*Currently reserved for multidrug-resistant Gram-negative infections, including resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacterales

	===Mechanism of Action===		===Mechanism of Action===
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	*Intrinsic resistance in [[Neisseria species]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], [[Proteus species]], [[Serratia marcescens]], [[Morganella morganii]], [[Providencia species]], [[Chromobacterium species]], [[Brucella species]], [[Inquilinus species]], [[Pandoraea]], and [[Burkholderia species]]		*Intrinsic resistance in [[Neisseria species]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], [[Proteus species]], [[Serratia marcescens]], [[Morganella morganii]], [[Providencia species]], [[Chromobacterium species]], [[Brucella species]], [[Inquilinus species]], [[Pandoraea]], and [[Burkholderia species]]

			===Pharmacokinetics and Pharmacodynamics===
	===PK/PD===

			*Distribution:
			**CMS is about 50% protein bound
			**Distributes well into liver, kidney, heart, and muscle
		⚫	**Poor distribution into bones, cerebrospinal fluid, lung parenchyma, and pleural cavity
			*Metabolism: Can take up to 36 hours to achieve steady state colistin during administration of CMS
			*Elimination:
			**Two-thirds of CMS is eliminated unchanged by the kidneys
			**Colistin is cleared by unknown non-renal and non-biliary routes
	*Concentration-dependent activity		*Concentration-dependent activity
⚫	*Poor distribution into ~~pleural~~ fluid, ~~joints~~, and ~~CSF~~

	==Dosing==		==Dosing==

	===~~Intravenous~~ Dosing===		=== Dosing Equivalents ===

	*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)		* Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
	**1 MIU = 80 mg colistimethate (CMS) in Europe		**1 MIU = 80 mg colistimethate (CMS) in Europe
	**1 MIU = 30 mg colistin base activity (CBA) in the US		**1 MIU = 30 mg colistin base activity (CBA) in the US
			**1 mg of CMS = 0.375 mg of colistin base activity = 12,500 IU
			**1 mg of colistin base activity = 2.6 mg of CMS = 32,500 IU
			*IU is used in Europe while CBA is used in the US

			===Intravenous Dosing===

	*For European dosing, using IU of CMS:		*For European dosing, using IU of CMS:
	**Weight ≤60 kg: 50-75 kIU/kg/day divided q8h		**Weight ≤60 kg: 50-75 kIU/kg/day divided q8h
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	*Exists.		*Exists.

			=== Inhalational Dosing ===

			* CMS is dissolved in 4–6 ml of normal saline or sterile water and given by nebulizer
			** Results in low systemic levels
			* Body weight <40 kg: 0.5 MIU (40 mg) of CMS every 12 h
			* Body weight >40 kg: 1.0 MIU (80 mg) of CMS every 12 h
			* For recurrent or severe pulmonary infection: 2.0 MIU (160 mg) of CMS every 8 h

			=== Renal Dosing ===

			* Serum creatinine level 115 to 132 μmol/L: 2 MIU (160 mg) of CMS every 8 h
			* Serum creatinine level 141 to 221 μmol/L: 2 MIU (160 mg) of CMS every 12 h
			* Serum creatinine level ≥230 μmol/L: 2 MIU (160 mg) of CMS every 24 h
			* Hemodialysis: 2 MIU (160 mg) of CMS after each hemodialysis
			* Peritoneal dialysis: 2 MIU (160 mg) of CMS daily during peritoneal dialysis
			* Continuous renal replacement therapy (CRRT): high loading dose followed by a maintenance dose of up to 4.5 MIU every 8 h
			** Continuously eliminated, and needs higher dosing

	==Safety==		==Safety==
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	*International Consensus Guidelines for the Optimal Use of the Polymyxins. ''Pharmacotherapy''. 2019;39(1):10-39. doi: [https://doi.org/10.1002/phar.2209 10.1002/phar.2209]		*International Consensus Guidelines for the Optimal Use of the Polymyxins. ''Pharmacotherapy''. 2019;39(1):10-39. doi: [https://doi.org/10.1002/phar.2209 10.1002/phar.2209]
			*Colistin for lung infection: an update. ''J Intensive Care''. 2015;3(1):3. doi: [https://doi.org/10.1186/s40560-015-0072-9 10.1186/s40560-015-0072-9]

	[[Category:Polymyxins]]		[[Category:Polymyxins]]

Aidan: /* Spectrum of Activity */

2020-08-29T11:21:49Z

Spectrum of Activity

← Older revision		Revision as of 11:21, 29 August 2020
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	*Broadly active against [[Gram-negative bacteria]], including [[Enterobacterales]] and [[afermentative Gram-negative bacilli]]		*Broadly active against [[Gram-negative bacteria]], including [[Enterobacterales]] and [[afermentative Gram-negative bacilli]]
	*Not active against [[Gram-positive bacteria]], given that they don't have lipopolysaccharide		*Not active against [[Gram-positive bacteria]], given that they don't have lipopolysaccharide
			*Intrinsic resistance in [[Neisseria species]], [[Moraxella catarrhalis]], [[Helicobacter pylori]], [[Proteus species]], [[Serratia marcescens]], [[Morganella morganii]], [[Providencia species]], [[Chromobacterium species]], [[Brucella species]], [[Inquilinus species]], [[Pandoraea]], and [[Burkholderia species]]
	*Resistance often seen in:
	**''[[Brucella species\|Brucella]]''
	**''[[Burkholderia species\|Burkholderia]]''
	**[[Inquilinus limosus]]
	**[[Morganellaceae]] (''[[Proteus species\|Proteus]]'', ''[[Providencia species\|Providencia]]'', ''[[Morganella species\|Morganella]]'')
	**''[[Neisseria species\|Neisseria]]''
	**[[Pandoraea]]
	**''[[Serratia species\|Serratia]]''

	===PK/PD===		===PK/PD===
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	==Dosing==		==Dosing==

	=== Intravenous Dosing ===		===Intravenous Dosing===

	*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)		*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
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	**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis		**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis

	=== Intrathecal Dosing ===		===Intrathecal Dosing===

	* Exists.		*Exists.

	==Safety==		==Safety==

Aidan: /* Dosing */

2020-08-26T14:59:14Z

Dosing

← Older revision		Revision as of 14:59, 26 August 2020
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	**''[[Serratia species\|Serratia]]''		**''[[Serratia species\|Serratia]]''

	=== PK/PD ===		===PK/PD===

	* Concentration-dependent activity		*Concentration-dependent activity
	* Poor distribution into pleural fluid, joints, and CSF		*Poor distribution into pleural fluid, joints, and CSF

	==Dosing==		==Dosing==

			=== Intravenous Dosing ===

	*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)		*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
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	**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis		**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis

	== ~~Safety~~ ==		=== Intrathecal Dosing ===

			* Exists.

			==Safety==

	===Adverse Effects===		===Adverse Effects===
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	*Other neurological effects include peripheral paresthesia, tingling of tongue, dizziness, vertigo, blurred vision, slurred speech, ataxia		*Other neurological effects include peripheral paresthesia, tingling of tongue, dizziness, vertigo, blurred vision, slurred speech, ataxia

	== Further Reading ==		==Further Reading==

	* International Consensus Guidelines for the Optimal Use of the Polymyxins. ''Pharmacotherapy''. 2019;39(1):10-39. doi: [https://doi.org/10.1002/phar.2209 10.1002/phar.2209]		*International Consensus Guidelines for the Optimal Use of the Polymyxins. ''Pharmacotherapy''. 2019;39(1):10-39. doi: [https://doi.org/10.1002/phar.2209 10.1002/phar.2209]

	[[Category:Polymyxins]]		[[Category:Polymyxins]]

Aidan at 13:48, 26 August 2020

2020-08-26T13:48:21Z

← Older revision		Revision as of 13:48, 26 August 2020
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		⚫	==Background==

	*A member of the polymyxin class also known as polymyxin E		*A member of the polymyxin class also known as polymyxin E
	*Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)		*Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)
	*Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacteriaceae		*Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacteriaceae

⚫	==Background==
	===Mechanism of Action===		===Mechanism of Action===

			*Given as a prodrug, which is converted in vivo into the active drug (compared to [[polymixin B]], which is given in its active form)
	*Disrupt membranes by interacting with membrane phospholipids to displace divalent cations		*Disrupt membranes by interacting with membrane phospholipids to displace divalent cations
	*Also bind lipid A in the cell wall lipopolysaccharide		*Also bind lipid A in the cell wall lipopolysaccharide
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	*May be chromosomal (e.g. pmrC, pmrF, pmrAB, lpxA, lpxC, lpxD, OprH) or plasmid-mediated (e.g. mcr-1 gene)		*May be chromosomal (e.g. pmrC, pmrF, pmrAB, lpxA, lpxC, lpxD, OprH) or plasmid-mediated (e.g. mcr-1 gene)

	=== Spectrum of Activity ===		===Spectrum of Activity===

	* Broadly active against Gram-~~negatives~~		*Broadly active against [[Gram-negative bacteria]], including [[Enterobacterales]] and [[afermentative Gram-negative bacilli]]
	* Not active against Gram-~~positives~~		*Not active against [[Gram-positive bacteria]], given that they don't have lipopolysaccharide
	* Resistance often seen in:		*Resistance often seen in:
	** ''[[Brucella species\|Brucella]]''		**''[[Brucella species\|Brucella]]''
	** ''[[Burkholderia species\|Burkholderia]]''		**''[[Burkholderia species\|Burkholderia]]''
	** [[Inquilinus limosus]]		**[[Inquilinus limosus]]
	** [[Morganellaceae]] (''[[Proteus species\|Proteus]]'', ''[[Providencia species\|Providencia]]'', ''[[Morganella species\|Morganella]]'')		**[[Morganellaceae]] (''[[Proteus species\|Proteus]]'', ''[[Providencia species\|Providencia]]'', ''[[Morganella species\|Morganella]]'')
	** ''[[Neisseria species\|Neisseria]]''		**''[[Neisseria species\|Neisseria]]''
	** [[Pandoraea]]		**[[Pandoraea]]
	** ''[[Serratia species\|Serratia]]''		**''[[Serratia species\|Serratia]]''

			=== PK/PD ===

			* Concentration-dependent activity
			* Poor distribution into pleural fluid, joints, and CSF

	==Dosing==		==Dosing==
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	**2.5-5 mg/kg ideal body weight daily divided q12h to q6h		**2.5-5 mg/kg ideal body weight daily divided q12h to q6h
	**E.g. 300 mg CBA (10 IU) daily for a 60 kg patient, compared to 3 to 4.5 MIU daily in Europe		**E.g. 300 mg CBA (10 IU) daily for a 60 kg patient, compared to 3 to 4.5 MIU daily in Europe
			*Critically ill patients may benefit from a loading dose of 300 mg CBA followed by regular maintanance dosing in 12 to 24 hours
	*Per Mandell:		*Per Mandell:
	**5 mg CBA/kg IBW as loading dose (max 300 mg) followed by 5 mg CBA/kg IBW daily divided q8h		**5 mg CBA/kg IBW as loading dose (max 300 mg) followed by 5 mg CBA/kg IBW daily divided q8h
	**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis		**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis

	==~~Adverse~~ ~~Effects~~==		== Safety ==

			===Adverse Effects===

	*Prominent and common '''nephrotoxicity''', which is dose-related and usually reversible		*Prominent and common '''nephrotoxicity''', which is dose-related and usually reversible
	*Rarely, '''neuromuscular blockage''', which can cause weakness and apnea		*Rarely, '''neuromuscular blockage''', which can cause weakness and apnea
			*Other neurological effects include peripheral paresthesia, tingling of tongue, dizziness, vertigo, blurred vision, slurred speech, ataxia

			== Further Reading ==

			* International Consensus Guidelines for the Optimal Use of the Polymyxins. ''Pharmacotherapy''. 2019;39(1):10-39. doi: [https://doi.org/10.1002/phar.2209 10.1002/phar.2209]

	[[Category:Polymyxins]]		[[Category:Polymyxins]]

Aidan at 16:08, 21 August 2020

2020-08-21T16:08:38Z

← Older revision		Revision as of 16:08, 21 August 2020
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	*Also bind lipid A in the cell wall lipopolysaccharide		*Also bind lipid A in the cell wall lipopolysaccharide

	===Resistance===		===Mechanisms of Resistance===

	*Conferred by alterations in lipid A, either reducing its charge or eliminating it altogether		*Conferred by alterations in lipid A, either reducing its charge or eliminating it altogether
	*May be chromosomal (e.g. pmrC, pmrF, pmrAB, lpxA, lpxC, lpxD, OprH) or plasmid-mediated (e.g. mcr-1 gene)		*May be chromosomal (e.g. pmrC, pmrF, pmrAB, lpxA, lpxC, lpxD, OprH) or plasmid-mediated (e.g. mcr-1 gene)

	*Often seen in ''[[Proteus species\|Proteus]]'', ''[[Providencia species\|Providencia]]'', ''[[Serratia species\|Serratia]]'', ''[[Morganella species\|Morganella]]'', ''[[Burkholderia species\|Burkholderia]]'', ''[[Neisseria species\|Neisseria]]'', and ''[[Brucella species\|Brucella]]''
			=== Spectrum of Activity ===

			* Broadly active against Gram-negatives
			* Not active against Gram-positives
			* Resistance often seen in:
			** ''[[Brucella species\|Brucella]]''
			** ''[[Burkholderia species\|Burkholderia]]''
			** [[Inquilinus limosus]]
			** [[Morganellaceae]] (''[[Proteus species\|Proteus]]'', ''[[Providencia species\|Providencia]]'', ''[[Morganella species\|Morganella]]'')
			** ''[[Neisseria species\|Neisseria]]''
			** [[Pandoraea]]
			** ''[[Serratia species\|Serratia]]''

	==Dosing==		==Dosing==

Aidan: /* Resistance */

2020-08-11T00:22:30Z

Resistance

@@ Line 1: / Line 1: @@
-* A member of the polymyxin class also known as polymyxin E
+*A member of the polymyxin class also known as polymyxin E
-* Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)
+*Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)
-* Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacteriaceae
+*Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacteriaceae
-== Background ==
+==Background==
-=== Mechanism of Action ===
+===Mechanism of Action===
-== Dosing ==
+===Resistance===
 [[Category:Polymyxins]]