Acute renal failure caused by polymyxin B containing ointment

Area of Science:

• Nephrology
• Dermatology
• Pharmacology

Background:

• Non-insulin-dependent diabetes mellitus is a common comorbidity.
• Topical polymyxin B is frequently used for wound infections.
• Large leg ulcers present a significant treatment challenge.

Observation:

• A 67-year-old male diabetic patient developed acute renal failure.
• The patient had been treated with polymyxin B ointment for leg ulcers.
• Renal function improved after 13 days of peritoneal dialysis.

Findings:

• Topical polymyxin B application to extensive leg ulcers can precipitate acute kidney injury.
• The patient's creatinine clearance at discharge was 12 ml/min.
• Polymyxin B nephrotoxicity is a potential risk even with topical administration.

Implications:

• Clinicians should exercise caution when prescribing polymyxin B for large ulcers, especially in diabetic patients.
• Monitoring renal function is crucial during topical polymyxin B therapy for extensive wounds.
• Alternative treatments may be considered to avoid potential nephrotoxic effects.