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Why Is Polymyxin Only Used On The Skin?

  • Post category:Skin Care
  • Post last modified:May 27, 2024
  • Reading time:11 mins read

Polymyxin is a class of antibiotics primarily used for treating infections caused by Gram-negative bacteria. Despite its effectiveness, polymyxin is predominantly used topically rather than systemically. This article explores the reasons behind this limited use, focusing on its pharmacological properties, potential side effects, and clinical applications.

Pharmacological Properties of Polymyxin

Polymyxins, including polymyxin B and colistin (polymyxin E), are cationic polypeptide antibiotics that target the outer membrane of Gram-negative bacteria. They work by binding to the lipopolysaccharides and phospholipids in the bacterial cell membrane, disrupting its integrity and leading to cell death. This mechanism makes polymyxins highly effective against multidrug-resistant bacteria such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae.

Systemic Toxicity

One of the primary reasons polymyxin is not used systemically is its significant toxicity. When administered parenterally, polymyxin can cause severe nephrotoxicity (kidney damage) and neurotoxicity (nerve damage). These adverse effects are dose-dependent and can limit the therapeutic use of polymyxins.


Polymyxins are known to cause acute kidney injury, which is characterized by a rise in serum creatinine and blood urea nitrogen levels. The nephrotoxic effects are believed to result from the drug’s ability to disrupt cell membranes in the renal tubules, leading to cell death and impaired kidney function. This toxicity is a significant concern, especially in patients with pre-existing kidney conditions or those receiving other nephrotoxic drugs.


Neurotoxic effects of polymyxins include dizziness, ataxia, visual disturbances, and, in severe cases, seizures and neuromuscular blockade. These effects are thought to arise from the drug’s interaction with neuronal cell membranes, leading to cell damage and dysfunction. The risk of neurotoxicity is heightened when polymyxins are used in combination with other neurotoxic agents.

Limited Systemic Absorption

When applied topically, polymyxin exhibits minimal systemic absorption, which significantly reduces the risk of systemic toxicity. This property makes it suitable for treating localized infections without exposing the patient to the potential adverse effects associated with systemic administration. The limited absorption is due to the drug’s large molecular size and its affinity for binding to cell membranes, which restricts its penetration through intact skin.

Clinical Applications of Topical Polymyxin

Topical polymyxin is commonly used in combination with other antibiotics such as bacitracin and neomycin to treat minor skin infections, including cuts, scrapes, and burns. These combination products, available under brand names like Neosporin and Polysporin, are effective in preventing bacterial infections in minor wounds.

Minor Skin Infections

Polymyxin-containing ointments and creams are widely used to prevent and treat minor skin infections. These products are applied directly to the affected area, where they act locally to inhibit bacterial growth and promote healing. The combination of polymyxin with other antibiotics broadens the spectrum of activity, making these products effective against a variety of bacterial pathogens.

Ophthalmic and Otic Preparations

Polymyxin is also used in ophthalmic (eye) and otic (ear) preparations to treat bacterial infections in these areas. The drug’s ability to disrupt bacterial cell membranes makes it effective in treating infections such as conjunctivitis and otitis externa. These formulations are designed to deliver the drug directly to the site of infection, minimizing systemic exposure and reducing the risk of adverse effects.

Safety and Precautions

While topical polymyxin is generally safe, it is essential to use it as directed to avoid potential side effects. Overuse or misuse of topical antibiotics can lead to local irritation, allergic reactions, and the development of antibiotic resistance. Patients should follow the instructions provided by their healthcare provider or the product label to ensure safe and effective use.

Allergic Reactions

Allergic reactions to polymyxin can occur, although they are relatively rare. Symptoms may include redness, itching, and swelling at the application site. In severe cases, systemic allergic reactions such as hives, difficulty breathing, and swelling of the face, lips, tongue, or throat may occur. Patients experiencing these symptoms should discontinue use and seek medical attention immediately.

Avoiding Overuse

To prevent the development of antibiotic resistance, it is crucial to use polymyxin-containing products only when necessary and for the recommended duration. Overuse of topical antibiotics can lead to the emergence of resistant bacterial strains, making infections more challenging to treat in the future. Patients should avoid using these products for longer than one week unless directed by a healthcare provider.


Polymyxin is a potent antibiotic with a specific role in treating Gram-negative bacterial infections. However, its use is primarily limited to topical applications due to its significant systemic toxicity. When used topically, polymyxin is effective in preventing and treating minor skin infections with minimal risk of adverse effects. Understanding the pharmacological properties, potential side effects, and appropriate clinical applications of polymyxin is essential for its safe and effective use. By adhering to recommended guidelines and precautions, healthcare providers and patients can maximize the benefits of this valuable antibiotic while minimizing the risks associated with its use.


What is polymyxin used to treat?

Polymyxin is used to treat various infections caused by Gram-negative bacteria, including urinary tract infections, meningitis, blood infections, and eye infections. It is particularly effective against multidrug-resistant pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii, and carbapenem-resistant Enterobacteriaceae. Polymyxin B and colistin (Polymyxin E) are the primary forms used clinically, often as a last resort when other antibiotics fail.

What is the mechanism of action of polymyxin?

Polymyxin acts by binding to the lipopolysaccharides (LPS) and phospholipids in the outer membrane of Gram-negative bacteria. This binding displaces divalent cations like calcium and magnesium, destabilizing the membrane. The hydrophobic tail of polymyxin then inserts into the membrane, increasing its permeability, causing leakage of intracellular contents, and ultimately leading to bacterial cell death. This detergent-like mechanism disrupts both the outer and inner bacterial membranes.

What does polymyxin target on the cell membrane?

Polymyxin targets the lipopolysaccharides (LPS) in the outer membrane of Gram-negative bacteria. Specifically, it binds to the lipid A component of LPS, displacing divalent cations such as calcium and magnesium. This interaction destabilizes the membrane, leading to increased permeability and eventual cell death. The hydrophobic tail of polymyxin further disrupts the membrane structure, contributing to its bactericidal effect.

What is the function of polymyxin?

The primary function of polymyxin is to act as a bactericidal agent against Gram-negative bacteria. It disrupts the bacterial cell membrane, leading to increased permeability and leakage of intracellular contents, which results in cell death. Polymyxin is particularly used to treat infections caused by multidrug-resistant Gram-negative bacteria, making it a critical option for severe infections where other antibiotics are ineffective.

What are the main side effects of using Polymyxin on the skin?

The main side effects of using polymyxin on the skin include a burning sensation, redness, swelling, and pain at the application site. Other possible side effects are itching, rash, and hives. While these reactions are generally mild, more severe side effects like dizziness, drowsiness, and headache can occur. If any severe reactions or persistent symptoms are experienced, it is important to contact a healthcare provider immediately.

How does Polymyxin interact with other medications?

Polymyxin can interact with several other medications, potentially increasing the risk of nephrotoxicity and neurotoxicity. It may interact with aminoglycosides (e.g., gentamicin, tobramycin), muscle relaxants, and certain diuretics, enhancing their toxic effects. Additionally, combining polymyxin with other antibiotics can sometimes have synergistic effects, improving efficacy against resistant bacteria. It is crucial to inform healthcare providers of all medications being taken to avoid adverse interactions.