The sharp increase in carbapenem resistance in Gram-negative pathogens during the past decade led to a resurgence in the use of polymyxin antibiotics. Despite treatment-associated acute kidney injury and varying clinical outcomes, both colistin (polymyxin E) and polymyxin B have emerged as key therapies in the management of carbapenem-resistant Gram-negative infections. Use of these therapies is particularly frequent in low-income and middle-income countries where access to novel antibiotics that are active against carbapenem-resistant Gram-negative bacteria, such as ceftazidime plus avibactam and ceftolozane plus tazobactam, is restricted.
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