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Polymyxin B
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Polymyxin B is a mixture of polymyxins B1 and B2, obtained from Bacillus polymyxa strains, with antibacterial activity. They are basic polypeptides of about eight amino acids and have cationic detergent action on cell membranes. Polymyxin B is used for infections with gram-negative organisms, notably for treatment of infections of the urinary tract, meninges, and blood stream, caused by susceptible strains of Pseudomonas aeruginosa (1). It is often used in combination (compounded) with other antibiotics such as bacitracin or neomycin, especially in ophthalmic and ear preparations.
Adverse Reactions to Antibiotics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Diane M. Parente, Cheston B. Cunha, Michael Lorenzo
Neuromuscular blockade is a potential side effect of aminoglycosides, particularly after intraperitoneal administration [102]. Polymyxins may also result in neuromuscular blockade. Characteristic signs occur soon after drug administration and include acute paralysis and apnea. Aminoglycosides and polymyxins should be avoided in patients with myasthenia gravis, owing to exacerbation of neuromuscular weakness. Paresthesias can occur in up to 27% of patients on polymyxins and is more common with intravenous versus intramuscular use (7%) [107]. Polymyxin neurotoxicity is theorized to be dose-dependent, with high binding to brain tissue and increased interaction with neurons. Risk factors for polymyxin-induced neurotoxicity include concomitant administration of narcotics, sedatives, anesthetic agents, corticosteroids, and/or muscle relaxants, which are all commonly used in CCU patients. Polymyxins can also cause peripheral neuropathy, visual disturbances, vertigo, confusion, partial deafness, hallucinations, and seizures.
Polymyxins
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
CMS has been used in patients with cystic fibrosis since the 1990s (Bosso et al., 1991; Conway et al., 2000, 1997; Ledson et al., 1998; Littlewood et al., 2000). The polymyxins are increasingly used as a last-line therapy for a range of infections (e.g. pneumonia, bacteremia, urinary tract infections, catheter- related infections, meningitis, surgical site infections) caused by organisms such as P. aeruginosa, A. baumannii, Klebsiella species, and E. coli, which are resistant to commonly used antibiotics. Often the patients with these infections are critically ill and require intensive care.
Synergistic effect of silver nanoparticles and polymyxin B against biofilm produced by Pseudomonas aeruginosa isolates of pus samples in vitro
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Muhammad Salman, Rizwana Rizwana, Hayat Khan, Iqbal Munir, Muhammad Hamayun, Aquib Iqbal, Abdul Rehman, Khalid Amin, Ghayour Ahmed, Majid Khan, Ajmal Khan, Faiz Ul Amin
Emerging of MDR bacterial strains is the main issue. Pseudomonas aeruginosa is one of the leading MDR among other bacteria. As these bacteria are resistant to antibiotics, thus for treatment of infections, new strategies are required. Polymyxin B antibiotic in the previous years were used to treat infections but its use was banned due to its nephrotoxicity and neurotoxicity. In the present situation, due to the strong resistance of bacteria towards other antibiotics, Polymyxin B is the last choice of drug to treat infections. Our study is based on the synergistic effect of AgNPs combined with Polymyxin B in order to reduce the dose of Polymyxin B, thus decreasing its toxicity towards the host. It is demonstrated that NPs possesses broad-spectrum antibacterial properties against both gram-positive and gram-negative bacteria [29]. Some studies showed the concentration dependent antimicrobial activity of AgNPs against E. coli and P. aeruginosa is also investigated [30].
Strategies for the eradication of extended-spectrum beta-lactamase or carbapenemase-producing Enterobacteriaceae intestinal carriage
Published in Expert Review of Anti-infective Therapy, 2019
Gaud Catho, Benedikt D Huttner
One major concern related to oral decontamination with antibiotics such as polymyxins or aminoglycosides is that it could be associated with further development of antimicrobial resistance to these drugs. Polymyxins are currently one of the last-resort antibiotics for the treatment of multidrug-resistant (MDR) Gram-negative bacterial infections [69]. The few randomised trials who looked at this issue as a secondary outcome showed no increase resistance to polymyxin in the treatment group [18,33,38]. Huttner et al. observed no statistically significant changes in the colistin or neomycin minimal inhibitory concentration (MIC) between baseline and final ESBL-E isolates amongst treated patients compared to patients receiving placebo [18]. However, colistin resistance was detected in the fecal flora of two patients in two strains of non ESBL or carbapenemase-producing Enterobatceriaceae using a special medium (V. De Latours, personal communication). In one prospective-controlled trial conducted in a 1,000-bed tertiary care center in northern Israel, secondary resistance was reported in 7 of the 50 (14%) selective digestive decontamination-treated patients, gentamicin resistance in 6 of 26 gentamicin-treated patients, and colistin resistance in 1 of 16 colistin-treated patients [67].
Polymyxin B and colistin—the economic burden of nephrotoxicity against multidrug resistant bacteria
Published in Journal of Medical Economics, 2019
Felipe F. Tuon, Jaime L. Rocha, Juliano Gasparetto
Considering that polymyxins have high nephrotoxicity rates, which may demand dialysis treatments8–10, any drug with less nephrotoxicity would be beneficial. In the era of new antibiotics, toxicity has been of great concern. In general, new drugs should be less toxic than older drugs. Typical examples are drugs against Staphylococcus aureus, such as daptomycin and linezolid. Both drugs are less nephrotoxic than vancomycin and they present a better microbiological response, despite having similar mortality15. However, the price of new drugs is too high, and most Brazilian hospitals did not include these drugs in their therapeutic arsenal. Pharmacoeconomic studies are extremely important to help payers considering inclusion of new technologies and new drugs.