Abstract
ABSTRACT
Background
The polymyxins, polymyxin B and colistin, are last‐line options for the treatment of infections caused by drug‐resistant gram‐negative organisms. The comparative neurotoxicity of these agents using contemporary dosing is poorly understood. We sought to compare the incidence of neurotoxicity among recipients of polymyxin B or colistin.
Methods
This was a single‐center, retrospective cohort study of all patients who received colistin or polymyxin B for the treatment of a serious gram‐negative infection between March 2016 and April 2020. The primary outcome of interest was treatment‐emergent neurotoxicity, defined as new‐onset perioral paresthesia, non‐oral paresthesia, peripheral neuropathy, seizure, diaphragmatic paralysis, or other neurotoxicity. Bivariate analyses were performed using Fisher's exact test and the Wilcoxon rank‐sum test; no multivariable analyses were performed.
Results
A total of 82 patients receiving polymyxin B (
n
= 39) or colistin (
n
= 43) were identified. Neurotoxicity, nearly exclusively paresthesia, was more commonly seen in recipients of polymyxin B (10/39 evaluable patients, 26%) versus colistin (1/42 evaluable patients, 2%;
p
Conclusions
Polymyxin B is associated with significantly more neurotoxicity than colistin in unadjusted analyses. This potential risk should be considered when choosing between these two agents.