Polymyxin B-induced rhabdomyolysis

Abstract

Rationale: Polymyxin B has been used to treat extensively drug-resistant gram-negative bacteria and shown a better antibacterial effect in the clinic at present. Meanwhile, polymyxin B is associated with several adverse effects. However, there is a lack of awareness that polymyxin B can cause rhabdomyolysis. In this study, we firstly report a case of polymyxin B-induced rhabdomyolysis during antiinfection therapy. Patient concerns: A 70-year-old woman suffering from rheumatic heart disease underwent aortic and mitral valve replacement at our institute. Subsequently, she developed bacteremia and pneumonia caused by extensively drug resistance-acinetobacter baumannii. Polymyxin B was administered for 5 days. During treatment, the patient complained of muscle pain and limb weakness, and her serum creatine phosphokinase and myoglobin levels rose. Diagnosis: The clinical symptoms and laboratory examination confirmed rhabdomyolysis, and polymyxin B-induced rhabdomyolysis was considered. Intervention: We ceased polymyxin B treatment and monitored the patient daily. Outcomes: Serum creatine phosphokinase levels returned to normal, myoglobin levels decreased, and muscle pain was significantly alleviated after cessation of polymyxin B. We identified this as a case of polymyxin B-induced rhabdomyolysis. Lessons: Here, we report the first reported case of rhabdomyolysis induced by polymyxin B administration. The awareness of rare adverse reaction helps ensure the clinical safety of polymyxin B treatment.

Polymyxins leading to nephrotoxicity

“…28 According to the current agreement, polymyxin B dosages should be based on body weight (2.0-2.5 mg/kg as a loading dose, followed by 1.25-1.5 mg/kg every 12 hours) and adjusted in accordance with renal function. 29 These medications' therapeutic usefulness will likely be extended with effective and prudent use. It is hoped that polymyxins will act as a stopgap until new and effective treatments are created.…”