Our world is facing an enormous disaster due to spreading of the life-threatening bacterial infections, especially after the spread of multidrug-resistant Gram-negative bacteria (MDR-GNB), including those resistant to known antibiotics such as fluoroquinolones, aminoglycosides, broad-spectrum penicillins, and other β-lactams antibiotics, such as monobactams and carbapenem. In addition, the a shortage of the production of new drugs that are able to overcome these life-threatening infections. This disaster has pushed the medical profession to re-use colistin, the old antibiotic, as the last hope drug for the treatment of these fatal infections. Colistin was discovered in 1950 and was rejected in most parts of the world due to its toxicity including nephrotoxicity. Unfortunately, the resistance against colistin has been discovered and this resistance has spread globally. Colistin resistance includes both intrinsic resistance and acquired resistance. The mechanisms of acquired colistin resistance were linked only to the chromosomal gene mutations until the discovery of the colistin resistance gene named the mobile colistin-resistant (mcr) gene which is mediated by the plasmid. In this review, we discuss the history, chemistry, spectrum of activity, mechanism of action, clinical uses and indications, adverse effects, mechanisms of colistin resistance, and antibiotic combinations with colistin.
nd indications, adverse effects, mechanisms of colistin resistance and antibiotic combinations with colistin.