Case Report: Respiratory paralysis associated with polymyxin B therapy

Area of Science:

• Pharmacology
• Infectious Diseases
• Critical Care Medicine

Background:

• Polymyxin B (PMB) and colistin are polypeptide antibiotics crucial for treating multidrug-resistant Gram-negative bacterial infections.
• Historically, PMB use declined due to nephrotoxicity and neurotoxicity, but its efficacy against resistant strains has led to a resurgence.
• The full spectrum of PMB's adverse effects, particularly neuromuscular complications, requires further elucidation.

Observation:

• A patient receiving intravenous Polymyxin B experienced respiratory paralysis.
• This adverse event is a rare but potentially fatal complication associated with PMB-induced neuromuscular blockade.
• The case suggests a probable link between the Polymyxin B infusion and the onset of respiratory paralysis.

Findings:

• Polymyxin B can induce neuromuscular blockade, leading to respiratory paralysis.
• Prompt recognition and management of respiratory compromise are essential in patients treated with PMB.
• This case underscores the importance of vigilance regarding rare but severe side effects of antibiotics.

Implications:

• Clinicians should be aware of the risk of respiratory paralysis with Polymyxin B, especially in susceptible patients.
• Enhanced monitoring for neuromuscular blockade is warranted during PMB therapy.
• Further research into the mechanisms and prevention of PMB-induced neurotoxicity is needed to optimize patient safety.