Which antibiotic class is used as a last resort for MDR Gram-negative infections and has notable nephrotoxic and neurotoxic risks?

Which antibiotic class is used as a last resort for MDR Gram-negative infections and has notable nephrotoxic and neurotoxic risks?

• A. Polymyxins
• B. Tetracyclines
• C. Macrolides
• D. Sulfonamides

Answer: (A)

In treating MDR Gram-negative infections, some antibiotics are reserved as a last resort because of significant toxicity. Polymyxins are among the handful of options kept for these difficult cases, since they can kill many MDR Gram-negative bacteria by disrupting the bacterial outer membrane. They bind to lipopolysaccharide and destabilize the membrane, which makes them active against organisms like Pseudomonas, Acinetobacter, and carbapenem-resistant Enterobacterales. But this potent action comes with notable risks: nephrotoxicity (kidney injury) and neurotoxicity (including dizziness, paresthesias, and, in some cases, neuromuscular effects). Because of these potential harms, polymyxins are used with careful dosing, close monitoring of kidney function, and often in combination therapy to balance efficacy and safety. The other classes listed do not provide the same reliable activity against MDR Gram-negative infections and generally do not carry the same level of these specific toxicity concerns in this context.

In treating MDR Gram-negative infections, some antibiotics are reserved as a last resort because of significant toxicity. Polymyxins are among the handful of options kept for these difficult cases, since they can kill many MDR Gram-negative bacteria by disrupting the bacterial outer membrane. They bind to lipopolysaccharide and destabilize the membrane, which makes them active against organisms like Pseudomonas, Acinetobacter, and carbapenem-resistant Enterobacterales. But this potent action comes with notable risks: nephrotoxicity (kidney injury) and neurotoxicity (including dizziness, paresthesias, and, in some cases, neuromuscular effects). Because of these potential harms, polymyxins are used with careful dosing, close monitoring of kidney function, and often in combination therapy to balance efficacy and safety. The other classes listed do not provide the same reliable activity against MDR Gram-negative infections and generally do not carry the same level of these specific toxicity concerns in this context.