Abstract
Neurotoxicity of polymyxins is a side effect of concern that is less
known in comparison to nephrotoxicity. The symptoms consist of a wide
range of mild to severe, from simple paresthesia to neuromuscular
blockade of respiratory symptoms and apnea. The goal of this review is
collecting the data about neurotoxicity of polymyxins and description of
clinical course of incidence of this side effect. All clinical trials,
prospective, retrospective, case series and case reports containing the
key words “neurotoxicity”, “polymyxin”, “polymyxin B”, and
“colistin” were evaluated. Clinical course of the side effect was
assessed and reported. Also, the studies which report no occurrence of
the side effect were also evaluated. A total of 36 articles were found
that have reported neurotoxic effects of polymyxins. Total cases were
264 patients and the most reported symptoms was paresthesia and
tingling, especially in facial and perioral area. Dizziness, weakness,
altered mental status, and seizure was also reported. The sample size of
the articles that report neurotoxicity and the one that did not detect
it (twenty-six investigations) were all accumulated. A frequency of
7.64% is calculated for this side effect. The data about rechallenge or
adjustment of dose is still lacking. The most prevalent symptom of
neurotoxicity of polymyxin is paresthesia. More serious side effects
like seizure and apnea can happen. Most of the cases has happened after
loading dose. The incidence of the adverse effect is estimated as
7.64%. Rechallenge of polymyxin is still a field of question.