Use of polymyxin B in patients with renal impairment: A retrospective examination of 5 cases

Abstract

In order to provide an idea dose of polymyxin B in Chinese patients with renal impairment, the present study collected the clinical data of all patients with renal impairment who received polymyxin B therapy in the intensive care unit (ICU) of The First Affiliated Hospital of Bengbu Medical College (Bengbu, China). The clinical data of six patients treated in the ICU between February 2018 and May 2019 were retrospectively analyzed. All patients had renal impairment and were treated with polymyxin B combination therapy. The patients in the current study received polymyxin B and carbapenem, or polymyxin, carbapenem, cefoperazon and sulbactam, or polymyxin B, carbapenems and aminoglycoside treatment. One patient discontinued treatment. The other five patients received polymyxin B at a dosage of 50 mg every 12 h (100 mg/day) through an intravenous drip. During treatment, four of the five patients had deteriorating renal function to varying degrees, and continuous renal replacement therapy (CRRT) was initiated. Polymyxin B was discontinued in all patients when the infection was controlled. After treatment, four of five patients showed improvement in renal function, and had normal kidney function at the 1-month follow-up evaluation, whereas one patient had chronic renal disease. During hospitalization, one patient experienced neurotoxicity, showing decreased limb muscle strength and cognitive impairment, which might have been caused by polymyxin B, according to the Naranjo adverse drug reactions probability scale (also known as the Naranjo algorithm) score. The present report demonstrated that the administration of 100 mg daily dosage of polymyxin B to the five patients weighing between 50 and 75 kg, could control pulmonary infection during the course of treatment of Chinese patients with renal impairment, however, further research is needed to verify this result. Risk factors for nephrotoxicity and neurotoxicity need to be fully assessed before initiating polymyxin B therapy in patients with renal impairment.

A novel decoy strategy for polymyxin resistance in Acinetobacter baumannii

“…The reasons underlying our unexpected observation of sensitivity of the Gram-positive Enterococcus strains to PMB under anaerobic conditions remain to be elucidated (Figure 7A). Recently, more studies suggested that polymyxins can bind to teichoic acid, which is a negatively charged compound in the OM of Gram-positive bacteria (Brown et al, 2013;Rudilla et al, 2018;Yu et al, 2020). We speculated that different degrees of teichoic acid-like production might occur in anerobic culture conditions.…”

Polymyxin B in Patients With Renal Impairment: Is It Necessary to Adjust Dose?

“…There are also some studies that supported the view that the polymyxin B dose should be adjusted in renal impairment patients ( Table 1 , Entries 10–13). In 2020, Yu et al ( Yu et al, 2020 ) demonstrated that a relatively low dose of polymyxin B (a 100-mg daily dose for patients weighing between 50 and 75 kg) could control pulmonary infections in patients with renal impairment ( Table 1 , Entry 10). In 2021, Yu et al ( Yu et al, 2021 ) developed a population pharmacokinetic model of polymyxin B and Monte Carlo simulations on the basis of a retrospective study in 32 adult patients with varying renal function.…”