ABSTRACT
The advent of the first sulfonamides in 1935 saw the beginning of an era of antimicrobial therapy which has been characterized by a dramatic reduction in the incidence of mortality and morbidity of infectious disease. However, during the development of the field of therapeutics, new antimicrobial drugs have rapidly appeared and just as quickly disappeared, and within a few years are apparently forgotten. Otologically, the polypeptide antibiotics of interest are the polymyxins, vancomycin and ristocetin. The polymyxins are a group of basic polypeptides of molecular weight approximately 1100, and contain several amino acids in addition to 6-methylocatanoic acid, a C fatty acid. In a study of the effect of application of neomycin, polymyxin B, and Colistin to the middle ear of guinea pigs, it was found that significant cochlear pathology resulted from this administration. Systemically administered polymyxins are excreted via the kidneys, and in renal insufficiency, excretion is markedly impaired with rapid accumulation to toxic levels.
