Colistin and its role in the Era of antibiotic resistance: an extended review (2000–2019)

Mohamed Abd El Gawad El-Sayed Ahmed, Lan Lan Zhong, Cong Shen, Yongqiang Yang, Yohei Doi, Guo Bao Tian

Research output: Contribution to journalReview articlepeer-review

317 Citations (Scopus)


Increasing antibiotic resistance in multidrug-resistant (MDR) Gram-negative bacteria (MDR-GNB) presents significant health problems worldwide, since the vital available and effective antibiotics, including; broad-spectrum penicillins, fluoroquinolones, aminoglycosides, and β-lactams, such as; carbapenems, monobactam, and cephalosporins; often fail to fight MDR Gram-negative pathogens as well as the absence of new antibiotics that can defeat these “superbugs”. All of these has prompted the reconsideration of old drugs such as polymyxins that were reckoned too toxic for clinical use. Only two polymyxins, polymyxin E (colistin) and polymyxin B, are currently commercially available. Colistin has re-emerged as a last-hope treatment in the mid-1990s against MDR Gram-negative pathogens due to the development of extensively drug-resistant GNB. Unfortunately, rapid global resistance towards colistin has emerged following its resurgence. Different mechanisms of colistin resistance have been characterized, including intrinsic, mutational, and transferable mechanisms. In this review, we intend to discuss the progress over the last two decades in understanding the alternative colistin mechanisms of action and different strategies used by bacteria to develop resistance against colistin, besides providing an update about what is previously recognized and what is novel concerning colistin resistance.

Original languageEnglish
Pages (from-to)868-885
Number of pages18
JournalEmerging Microbes and Infections
Issue number1
Publication statusPublished - 01-01-2020

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Parasitology
  • Microbiology
  • Immunology
  • Drug Discovery
  • Infectious Diseases
  • Virology


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