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Victor Hugo Ahumada Topete,1,* Kevin Jesus de Dios Sanchez,1,* Gustavo Alejandro Casas Aparicio,2 Graciela Hernandez Silva,2 Cesar Emmanuel Lopez Vejar,1 Luz Maria Torres Espíndola,3 Arnoldo Aquino-Galvez,4 Odalis Rodriguez Ganen,5 Manuel de Jesus Castillejos Lopez1 1Hospital Epidemiology and Infectology Unit, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico; 2Department of Infectious Disease Research, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico; 3Laboratory of Pharmacology, National Institute of Pediatrics, Mexico City, Mexico; 4Molecular Biology Laboratory, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico; 5Department of Hospital Pharmacy, National Institute of Respiratory Diseases Ismael Cosío Villegas, Mexico City, Mexico*These authors contributed equally to this workCorrespondence: Manuel de Jesus Castillejos Lopez; Arnoldo Aquino Galvez, Email mcastillejos@gmail.com; araquiga@yahoo.comAbstract: The adverse events related to sodium colistimethate have had variability regarding the prevalence of nephrotoxicity, neurotoxicity, and less frequent respiratory depression. In recent years, its use has been relevant due to the increase of multidrug-resistant bacteria since it is considered the last-line drug, being its main adverse event and reason for discrepancies between authors’ nephrotoxicity. The indiscriminate use of antibiotic therapy has generated multiple mechanisms of resistance, the most common being related to Colistin, the bactericidal escape effect. Based on the search criteria, no randomized clinical trials were identified showing safety and efficacy with the use of Colistin, inferring that the application of the appropriate dose is governed by expert opinion and retrospective and prospective observational studies, which confounding factors such as the severity of the patient and the predisposition to develop acute renal failure are constant. In this review, we focus on identifying the mechanism of nephrotoxicity and bacterial resistance, where much remains to be known.Keywords: colistin, colistimethate, nephrotoxicity, neurotoxicity, resistance mechanism, multidrug-resistant gram-negative bacteria, risk factors, high doses, toxicity