Polymyxin B

Common name: Polymyxin B Sulfate for Injection

Trade name: Yale

Full names: Polymyxin B Sulfate for Injection, Yale, Polymyxin B Sulfate for Injection

Indications:

Clinically used to fight infections caused by Gram-negative bacilli, mainly Pseudomonas aeruginosa. Including urinary tract infections, meningitis, lung infections, sepsis, and skin, soft tissue, eye, ear, joint infections, etc. It also has a good therapeutic effect on infections caused by other negative bacteria such as Aerobacillus aerogenes, Escherichia coli, Pneumoniae bacilli, and influenzae bacilli. There is no complete cross-resistance between bacteria and polymyxin E.

Usage and dosage:

This product is for intramuscular injection or intravenous infusion

Intramuscular injection: calculated as 10,000-20,000 units per kilogram of body weight per day, injected in 3 times, dissolved in an appropriate amount of water for injection or sodium chloride injection before application.

Intravenous drip: 500,000-1,000,000 units per day, administered in 2 doses. Dissolve and dilute with appropriate amount of sodium chloride injection or glucose injection before application.

Intrathecal injection: 10,000-50,000 units per day for adults, 5,000-20,000 units per day for children. After 3-5 days, it is changed to once every other day, and the course of treatment is 2-3 weeks. Dissolve with appropriate amount of sodium chloride injection before use.

Adverse reactions:

Nephrotoxicity: proteinuria, casturia, azotemia, increased blood drug levels without increasing the dose.

Neurotoxicity: Facial flushing, dizziness and ataxia, drowsiness, peripheral sensory abnormalities, apnea due to concurrent use of tubocurarine muscle relaxants, other neurotoxic drugs or unintentional overdose, meningeal irritation symptoms due to intrathecal administration, such as fever, headache, neck stiffness, increased cell count and protein in the cerebrospinal fluid.

Other reported adverse reactions: drug fever, urticaria, intramuscular injection pain (severe), phlebitis at the intravenous administration site.

Contraindications:

Contraindicated for those allergic to polymyxin.

Notes:

General: Using polymyxin B or prophylaxis in patients without proven or strongly suspected bacterial infection may not benefit and may increase the risk of increased drug resistance.

Basic renal function should be tested before treatment, and renal function and blood drug levels should be closely monitored during treatment. Avoid combination with tubocurarine muscle relaxants and other neurotoxic drugs (ether, tubocurarine, succinylcholine, galamine, decaquat and sodium citrate), which may cause respiratory depression. If symptoms of respiratory paralysis occur, respiratory assistance should be provided and medications should be discontinued. As with other antibiotics, use of this medication may cause overgrowth of non-susceptible bacteria, including fungi. If secondary infection occurs, appropriate plans should be formulated.

Patient Information: Patients should be informed that antibacterial drugs, including polymyxin B, are only used to treat bacterial infections and not viral infections (eg, the common cold).

When injectable polymyxin B sulfate is used to treat certain bacterial infections, patients should be informed that although the patient will feel better and better early in treatment, drug therapy should be followed exactly as directed. Failure to administer the drug as required or complete the course of treatment may (1) reduce the efficacy of direct treatment and (2) increase the development of drug resistance and cause future polymyxin B and other antibacterial drug treatments to be ineffective.

Diarrhea caused by antibiotics is a common problem that usually ends when the drug is discontinued. Watery and bloody stools (with or without stomach cramps and fever) sometimes occur after antibiotics are started, and sometimes they can occur two or more months after the last antibiotic. If this occurs, patients should contact their physician as soon as possible.

Storage:

Keep in a dark and airtight place and store in a cold place.

Mechanism of action:

Polymyxin B sulfate has a bactericidal effect on almost all Gram-negative bacteria except Proteus mirabilis. Polymyxins cause bacterial death by changing bacterial cell membrane permeability. Gram-positive bacteria, fungi, and Gram-negative cocci are resistant to polymyxin B. In vitro drug susceptibility testing of polymyxin B requires the use of appropriate methods. The following in vitro susceptibility test standards are only used to interpret the results of polymyxin B antibacterial activity against Pseudomonas aeruginosa when the quality control parameters are met.

Safety and efficacy:

Research and analyze the clinical use of polymyxin B sulfate for injection to provide reference for standardizing its clinical use and improving control measures. The researchers summarized the information of inpatients who used polymyxin B sulfate for injection in the hospital from January 1, 2018 to August 31, 2019, and analyzed the patient population characteristics, medication indications, usage and dosage, medication duration, combined medication and etiological examination results, clinical treatment outcomes and adverse reactions, etc. As a result, a total of 63 hospitalized patients using polymyxin B sulfate for injection were collected, including 40 male patients (64.06%) and 23 female patients (35.93%). The average age was (61.12±15.25) years old and the average length of stay was (66.54±56.98) days. Mainly distributed in 15 departments including the Respiratory Intensive Care Unit, Critical Care Medicine Department and Hematology Department. The top three infection categories were pulmonary infection (49 cases, 51.58%), bloodstream infection (23 cases, 24.21%) and abdominal infection (16 cases, 16.84%). All 63 patients had etiological examinations, and the inspection rate was 100%. In the end, 0 cases of patients were cured, 5 cases were markedly effective, 11 cases were improved, 16 cases were ineffective, and 23 cases died. 8 cases could not be judged because the medication time was ≤48 hours. A total of 17 patients (26.98%) developed acute kidney injury (AKI). According to the AKI staging, 10 cases were in AKI stage 1, 4 cases were in AKI stage 2, and 4 cases were in AKI stage 2. There were 3 patients who underwent continuous renal replacement therapy (CRRT) in Phase 3. Conclusion All patients in our hospital have clear indications for using polymyxin B sulfate for injection; the renal toxicity of polymyxin B sulfate for injection should not be underestimated and should be paid attention to in clinical use.