Johns Hopkins ABX Guide
Polymyxin B
INDICATIONS
FDA
FDA
- FDA legacy labeling for systemic administration:
- Serious infections caused by P. aeruginosa, H. influenzae, E. coli, K. aerogenes, and K. pneumoniae when alternative agents are contraindicated.
- Meningitis (intrathecal route ONLY)
- Contemporary clinical role: last-line or salvage therapy for selected extensively resistant Gram-negative infections when safer, more effective active agents are unavailable.
- Current IDSA guidance does not suggest either polymyxin B or colistin for CRE infections, except that colistin—not polymyxin B—may be considered for uncomplicated CRE cystitis.
- Ocular infections with or without steroids (e.g., bacterial conjunctivitis and blepharoconjunctivitis, ophthalmic drops)
NON-FDA APPROVED USES
NON-FDA APPROVED USES
- Historical or rarely used applications; not routinely recommended because of limited evidence, availability of alternatives, local hypersensitivity, and antimicrobial-stewardship concerns.
- Prophylaxis of superficial skin infections (topical)
- Irrigation of urinary bladder (adjunctive treatment)
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Last updated: October 11, 2026
Citation
Soto, Caitlin, and Kathryn Dzintars. "Polymyxin B." Johns Hopkins ABX Guide Johns Hopkins ABX Guide, The Johns Hopkins University, 2026. Johns Hopkins Guides, hopkinsguides.org/hopkins/view/Johns_Hopkins_ABX_Guide/540447/all/Polymyxin_B.
Soto C, Dzintars K. Polymyxin B. Johns Hopkins ABX Guide Johns Hopkins ABX Guide. The Johns Hopkins University; 2026. https://hopkinsguides.org/hopkins/view/Johns_Hopkins_ABX_Guide/540447/all/Polymyxin_B. Accessed October 13, 2026.
Soto, C., & Dzintars, K. (2026). Polymyxin B. In Johns Hopkins ABX Guide Johns Hopkins ABX Guide. The Johns Hopkins University. https://hopkinsguides.org/hopkins/view/Johns_Hopkins_ABX_Guide/540447/all/Polymyxin_B
Soto C, Dzintars K. Polymyxin B [Internet]. In: Johns Hopkins ABX Guide Johns Hopkins ABX Guide. The Johns Hopkins University; 2026. [cited 2026 October 13]. Available from: https://hopkinsguides.org/hopkins/view/Johns_Hopkins_ABX_Guide/540447/all/Polymyxin_B.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Polymyxin B
ID - 540447
A1 - Soto,Caitlin,PharmD, BCIDP
AU - Dzintars,Kathryn,Pharm.D., BCPS
Y1 - 2026/10/11/
BT - Johns Hopkins ABX Guide
UR - https://hopkinsguides.org/hopkins/view/Johns_Hopkins_ABX_Guide/540447/all/Polymyxin_B
PB - The Johns Hopkins University
DB - Johns Hopkins Guides
DP - Unbound Medicine
ER -
