Polymyxins are a class of antibiotics, including polymyxin B (PB) and polymyxin E (PE), that are commonly used in clinical settings as a last resort for the treatment of multidrug-resistant (MDR) Gram-negative bacterial infections. However, their high nephrotoxicity and neurotoxicity remain concerns.
The bactericidal activities of polymyxins against Gram-negative bacteria are mainly dependent on the electrostatic interactions between positively charged polymyxins and negatively charged lipopolysaccharide (LPS). Structural changes in LPS are currently common causes of resistance to polymyxins in Gram-negative bacteria. However, it is difficult to treat MRSA with polymyxins alone due to the lack of LPS in Gram-positive bacteria.
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