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Polymyxin B clinical outcomes: A prospective study of patients undergoing intravenous treatment

Karen P H Mattos1, Isabela R Gouvêa2, Júlia C F Quintanilha1

  • 1Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.

Journal of Clinical Pharmacy and Therapeutics
|January 23, 2019
PubMed
Abstract

Insights

Polymyxin B is a critical treatment for multidrug-resistant Gram-negative infections, but its clinical use in Brazil showed a low success rate (25.1%) and significant nephrotoxicity (40.5%). Careful patient selection is crucial for effective outcomes.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Medicine

Background:

  • Polymyxins, particularly polymyxin B, are vital last-resort treatments for carbapenemase-producing Gram-negative pathogens.
  • Increasing clinical use of polymyxin B necessitates evaluation of its therapeutic value due to associated toxicities.

Purpose of the Study:

  • To evaluate the efficacy and safety of polymyxin B antimicrobial therapy in Brazilian patients with multidrug-resistant bacterial infections.

Main Methods:

  • A prospective cohort study was conducted at a tertiary care center in Brazil.
  • Included patients received intravenous polymyxin B for at least 72 hours.
  • Assessed antimicrobial susceptibility, adverse reactions (nephrotoxicity, skin hyperpigmentation), and clinical outcomes (treatment success, mortality, failure).

Main Results:

  • Treatment success was achieved in 25.1% of 247 patients; mortality was 32.8%.
  • Nephrotoxicity occurred in 40.5% of patients.
  • Klebsiella pneumoniae, a carbapenemase producer, was most frequently linked to mortality (22.2%).

Conclusions:

  • Polymyxin B remains a primary therapy for carbapenemase-producing bacteria.
  • Its clinical application requires stringent criteria to optimize positive patient outcomes and mitigate risks.

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