Rare occurrence of polymyxin B-induced hyperpigmentation in a child with ventriculitis

Abstract

Polymyxin B (PB) is a polypeptide bactericidal antibiotic that is commonly used for extensively drug-resistant (XDR) microorganisms such asAcinetobacter baumaniiandKlebsiella pneumoniae. It can be administered intravenously or intrathecally. Common side effects are nephrotoxicity, neurotoxicity, pruritus and skin hyperpigmentation (SH). The latter is an uncommon adverse reaction of intravenously administered PB. We report a rare occurrence of PB-induced SH secondary to intrathecal administration of PB in a child withA. baumaniiXDR ventriculitis. We describe the management of him and a brief review of PB.

Intrathecal Injection of Polymyxin B in a Child with Meningitis Caused by Carbapenem-Resistant Pseudomonas aeruginosa: A Case Report and Literature Review

“…However, both of these adverse effects resolved following the completion of polymyxin B therapy. 18,19 No adverse events were observed during our treatment. The patient afflicted by Klebsiella pneumoniae infection succumbed to septic shock, with a persistent positive CSF culture at the time of death.…”

“…Another boy in early childhood received 5mg once per day. 19 International consensus guidelines recommend a once-daily intraventricular or intrathecal administration of 5 mg for adults. 7 The recommended polymyxin B dosing regimen specifies 5 mg for adults and older children.…”

“…But some studies found that P. aeruginosa carrying NDM-1 enzyme was resistant to polymyxin. 18 , 19 Given the limited and sporadic reports on intraventricular or intrathecal polymyxin B usage in pediatric patients, coupled with small sample sizes, further investigations are warranted to comprehensively assess the efficacy and potential adverse events associated with polymyxin B administration through intraventricular or intrathecal routes in children.…”

“…To date, only four articles have reported pediatric patients who underwent intrathecal or intraventricular administration of polymyxin B (Table 3). [16][17][18][19] Among them, all had received neurosurgical interventions. The preterm neonate accepted ventriculoperitoneal shunting after anti-infection therapy due to persistent hydrocephalus.…”