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What is Polymyxin B
Polymyxin B is a polypeptide antibiotic derived from a strain of Bacillus polymyxa.
Polymyxin B’s spectrum of activity is limited to gram-negative bacteria. Today, polymyxin B is rarely used systemically due to its potential for causing nephrotoxicity and/or neurotoxicity and the availability of less toxic agents.
Polymyxin B has been administered via inhalation for the treatment of Pseudomonas aeruginosa pnuemonia; however, this route of administration provides inconsistent concentrations of polymyxin B and is not considered effective.
It is more commonly administered as an ophthalmic, otic, or topical agent in combination with other antibiotics (i.e., bacitracin, clindamycin, gentamicin, neomycin, or trimethoprim B) and antiinflammatory agents (i.e., hydrocortisone).
Polymyxin B is also used in combination with neomycin as a urinary tract irrigant.
The FDA originally approved polymyxin B in 1951.
While the brandname product (Aerosporin(R)) has been discontinued by the manufacturer; polymyxin powder for injection and powder are available generically.
Indications
- bacteremia
- Escherichia coli
- Haemophilus influenzae (beta-lactamase negative)
- Haemophilus influenzae (beta-lactamase positive)
- Klebsiella pneumoniae
- meningitis
- nosocomial pneumonia
- ophthalmic infection
- pneumonia
- Pseudomonas aeruginosa
- urinary tract infection (UTI)
Side Effects
- anuria
- azotemia
- blurred vision
- confusion
- cylindruria
- dizziness
- drowsiness
- dysarthria
- fever
- flushing
- glomerulonephritis
- headache
- hematuria
- injection site reaction
- interstitial nephritis
- irritability
- myasthenia
- nephrotoxicity
- neurotoxicity
- nystagmus
- ocular irritation
- oliguria
- paresthesias
- phlebitis
- respiratory arrest
- superinfection
- urticaria
Monitoring Parameters
- serum creatinine/BUN
Contraindications
- breast-feeding
- colitis
- contact lenses
- diarrhea
- GI disease
- infection
- inflammatory bowel disease
- intramuscular administration
- intrathecal administration
- intravenous administration
- myasthenia gravis
- nephrotoxicity
- neuromuscular disease
- neurotoxicity
- polymyxin hypersensitivity
- pregnancy
- pseudomembranous colitis
- pulmonary disease
- renal disease
- renal failure
- renal impairment
- requires a specialized care setting
- respiratory insufficiency
- surgery
- ulcerative colitis
Interactions
- Amikacin
- Aminoglycosides
- Amlodipine; Celecoxib
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Bacitracin
- Bumetanide
- Capreomycin
- Carboplatin
- Celecoxib
- Cisplatin
- Cyclosporine
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir disoproxil fumarate
- Esomeprazole; Naproxen
- Ethacrynic Acid
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- Foscarnet
- Furosemide
- Ganciclovir
- General anesthetics
- Gentamicin
- Hyaluronidase, Recombinant; Immune Globulin
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Immune Globulin IV, IVIG, IGIV
- Indomethacin
- Kanamycin
- Ketoprofen
- Ketorolac
- Lamivudine; Tenofovir Disoproxil Fumarate
- Lansoprazole; Naproxen
- Loop diuretics
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Neuromuscular blockers
- Nonsteroidal antiinflammatory drugs
- Oral Contraceptives
- Oxaprozin
- Paromomycin
- Piroxicam
- Plazomicin
- Polymyxins
- Pyridostigmine
- Rofecoxib
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Streptomycin
- Sulindac
- Tacrolimus
- Telavancin
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Tobramycin
- Tolmetin
- Torsemide
- Valdecoxib
- Valganciclovir
- Vancomycin
- Verteporfin
- Warfarin
- Zoledronic Acid
