Indications

• Resistant Pseudomonas Aeruginosa (see Pseudomonas Aeruginosa, [[Pseudomonas Aeruginosa]])

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Pharmacology

• Polymyxin Antibiotic (see Polymyxins, [[Polymyxins]])

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Administration

• IV:
• Topical:
• Subconjunctival:

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Adverse Effects

• Neuromuscular Junction Antagonism with Respiratory Muscle Weakness (see Acute Hypoventilation, [[Acute Hypoventilation]] and Chronic Hypoventilation, [[Chronic Hypoventilation]])
  • Risk Factors for Neuromuscular Junction Antagonism
    • Intraperitoneal Adminsistration
    • Intrapleural Administartion
    • Chronic Kidney Disease (CKD)
    • Associated Use of Paralytics
  • Treatment: may respond to physostigmine

Renal Adverse Effects

• Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
  • Mechanism: acute tubular necrosis (ATN) [MEDLINE]

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References

• Characterization of polymyxin B-induced nephrotoxicity: implications for dosing regimen design. Antimicrob Agents Chemother. 2012 Sep;56(9):4625-9 [MEDLINE]
• Pharmacology of polymyxins: new insights into an ‘old’ class of antibiotics. Future Microbiol. 2013 Jun;8(6):711-24 [MEDLINE]
• Higher Incidence of Acute Kidney Injury With Intravenous Colistimethate Sodium Compared With Polymyxin B in Critically Ill Patients at a Tertiary Care Medical Center. Clin Infect Dis. 2013 Nov;57(9):1300-1303 [MEDLINE]