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ACCP Report - February 2019

Pharmacotherapy Releases International Consensus Guidelines for Optimal Use of the Polymyxins

Consensus Recommendations on Clinical Use of the Polymyxins as Salvage Therapy for Drug-Resistant Infections as Endorsed by ACCP, ESCMID, IDSA, ISAP, SCCM, and SIDP

International Consensus Guidelines for the Optimal Use of the Polymyxins


Although the polymyxins became available in the 1950s, interest in these agents as salvage therapy for multidrug-resistant and extensively drug-resistant gram-negative infections recently reemerged. However, the lack of standard drug development procedures in the 1950s resulted in significant confusion surrounding their use. To address this confusion and provide practitioners with a guide to optimal clinical use of the polymyxin antibiotics today, a diverse, international panel of 18 experts convened over a period of 24 months to reach a consensus on their optimal use, which was subsequently published in Pharmacotherapy (see

The expert panel was led by American College of Clinical Pharmacy (ACCP) members Brian Tsuji, Pharm.D., and Jason Pogue, Pharm.D., together with physician-collaborator Keith Kaye, M.D. This panel included members of all six of the endorsing organizations: ACCP, European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society of Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP).

As noted by Pharmacotherapy Editor-in-Chief C. Lindsay DeVane on the use of polymyxins and the new consensus on their optimal use,

Unfortunately, many clinicians encounter patients with infections caused by multidrug- and extensively drug-resistant microorganisms. Despite the polymyxins’ narrow therapeutic index, they can be an effective option. This practical framework for using the polymyxins should provide substantial guidance for drug therapy.


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