Overdoses with polymyxins, mainly with colistimethate sodium, have been reported several times in the old literature. Although, one case of a three year old child who received intramuscularly 450 mg (approximately 5.5 million IU) of colistimethate sodium reported no adverse effects, the majority of cases with Polymyxin overdose resulted in acuter renal failure and various manifestations of neurotoxicity, including neuromuscular blockade and apnea. It should be emphasized that cases of Polymyxin overdose with fatal consequences are scarce. There is no antidote for Polymyxin overdose. Management requires early cessation of the medication and appropriate supportive treatment. In the presence of established acute renal failure, haemodialysis and peritoneal dialysis can only manage renal complications, since they have little influence on the elimination of polymyxins, as discussed previously. If apnea occurs, mechanical ventilation support is needed.
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