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The worldwide rise of severe infections caused by multidrug-resistant Gram-negative bacteria in intensive care (IC) patients has propelled the “ancient warrior” antibiotic colistin back into the clinical arena.[1] Concomitantly, the pharmacokinetic and pharmacodynamic (PK/PD) behavior of antibiotics became a key topic of investigation in the critically ill. Within this context, the recognition of colistin as a concentration-dependent antibiotic resulted in a continuous “upgrading” of its dose in an attempt to optimize therapeutic efficacy and to reduce resistance. However, this revived the old concerns about increased renal and neurological toxicity that once caused colistin's demise from clinical use.[1]

Colistin pharmacokinetics/pharmacodynamics and acute kidney injury: A difficult but reasonable marriage