Polymyxin B and colistin are not well absorbed from the gastrointestinal tract. An intramuscular injection of the polymyxins results in high drug concentrations in the liver and kidneys, but the antibiotic does not enter the cerebrospinal fluid (CSF), even in the presence of inflammation.
The polymyxins are slowly excreted by glomerular filtration; the slow elimination rate is due to binding in tissues. Elimination is decreased in patients with renal disease, and drug accumulation can lead to toxicity. Sodium colistimethate, the parenteral preparation, binds less to tissue and is excreted faster than the free base.
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