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Polymyxin-induced neuromuscular weakness: a case report

Amanda X Y Chin1,2, Kay W P Ng1,2, Yee Cheun Chan1,2

  • 1Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.

Frontiers in Neurology
|April 11, 2024
PubMed

Insights

Polymyxin antibiotics can cause rare neuromuscular blockade, leading to respiratory failure. Early recognition and drug discontinuation rapidly reverse this potentially fatal condition.

Area of Science:

  • Pharmacology
  • Neurology
  • Infectious Diseases

Background:

  • Polymyxins are critical antibiotics for treating multi-drug resistant Gram-negative infections.
  • Polymyxin-induced neuromuscular blockade is a rare adverse effect, historically reported in the mid-20th century.

Observation:

  • A patient developed hypercapnic respiratory failure after starting polymyxin therapy for *Escherichia coli* bacteremia.
  • The patient exhibited neuromuscular dysfunction, including ptosis, consistent with polymyxin toxicity.

Findings:

  • Discontinuation of polymyxin led to rapid recovery of muscle strength and resolution of respiratory failure.
  • The patient was successfully extubated following cessation of the antibiotic.

Implications:

  • This case highlights the importance of recognizing polymyxin-induced neuromuscular blockade, especially with the resurgence of polymyxin use.
  • Prompt diagnosis and drug withdrawal are crucial for managing this reversible, life-threatening complication.
Keywords:
multi-drug resistanceneuromuscular blockadeneurotoxicitypolymyxinrenal impairmentrespiratory failure

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