Respiratory arrest associated with intravenous administration of polymyxin B sulfate

JAMA ◽  
1966 ◽  
Vol 196 (2) ◽  
pp. 181-183 ◽  
Author(s):  
G. Pohlmann
Keyword(s):  
Intravenous Administration ◽  
Polymyxin B ◽  
Respiratory Arrest

scholarly journals Polymyxins Nebulization over Intravenous Injection: Pharmacokinetics and Pharmacodynamics-Based Therapeutic Evaluation

2019 ◽  
pp. 1-10
Author(s):  
Md. Jahidul Hasan
Keyword(s):  
Respiratory Tract ◽  
Adverse Drug Reactions ◽  
Intravenous Administration ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Drug Reactions ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Gram Negative ◽  
Tract Infections

Polymyxins are the last line potential antibiotics against multi-drug resistant gram-negative bacteria and consist of two sister antibiotics: Polymyxin B and colistin (polymyxin E). Intravenous use of polymyxins was started from a long ago in the treatment of serious gram-negative infections and once their uses were restricted due to potential adverse drug reactions, such as nephrotoxicity and neurotoxicity. Lack of in vivo clinical studies on polymyxins mostly, in human body makes the pharmacokinetics and pharmacodynamics of polymyxin B and colistin unclear in many aspects, such as the distribution of polymyxins in different compartments of lung. The nebulization of polymyxins is practicing very limitedly and lack of clinical evidence has not justified this administration technique yet properly to date. The main objective of this review study was to evaluate the pharmacokinetic and pharmacodynamic properties of intravenous and nebulized polymyxins and the related therapeutic potentialities. Aerosolized polymyxins directly administered to the respiratory tract was found with higher drug concentration in different subcompartments of lungs than the intravenous administration and sustainably meets the minimum inhibitory concentration locally with superior bactericidal properties in respiratory tract infections. In contrast, intravenous administration of polymyxins shows similar anti-infective superiority in other organs, such as blood, urinary tract etc. So, during this alarming situation of rapidly emerging multidrug-resistant organisms in human communities, therapeutic administration techniques of last resort polymyxins should be clinically evidence-based for achieving optimum therapeutic outcomes with minimum chance of adverse drug reactions.  

scholarly journals Respiratory arrest associated with polymyxin B in a lung transplant patient

2020 ◽  
Vol 133 (11) ◽  
pp. 1375-1377 ◽  
Author(s):  
Wen-Hui Chen ◽  
Lan Lin ◽  
Xiao-Xing Wang ◽  
Xu-Dong Kong ◽  
Li-Juan Guo ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Transplant Patient ◽  
Polymyxin B ◽  
Respiratory Arrest

Polymyxin B infusion related respiratory arrest: A case report

2021 ◽  
Vol 6 (4) ◽  
pp. 241-244
Author(s):  
Subhajit Sen ◽  
Suresh Ramasubban ◽  
M. Surya Kumar ◽  
Sanjay Bhaumik ◽  
Debasis Rout
Keyword(s):  
Blood Stream Infection ◽  
Stable Condition ◽  
Kidney Injury ◽  
Polymyxin B ◽  
Blood Stream ◽  
Respiratory Arrest ◽  
Klebsiella Pneumonia ◽  
Carbapenem Resistant ◽  
History Of ◽  
Work Up

A 73 years old male, known hypertensive on medication, with the history of SARS-CoV-2 infection nine months ago, presented to us with mucormycosis, he was treated with Liposomal amphotericin B initially. He developed acute kidney injury with recurrent pulmonary oedema requiring ICU admission and Haemodialysis. He later developed catheter related blood stream infection that grew Carbapenem resistant Klebsiella pneumonia and was started on Polymyxin B. However from day 3 of antibiotics he started to develop recurrent respiratory arrest with no apparent cause. He required a brief period of mechanical ventilation and was successfully weaned. He had recurrent such episodes with no apparent cause. After extensive work up and literature search it was diagnosed as Polymyxin B induced respiratory failure. Polymyxins were stopped, patient was discharged in a stable condition after five days of further observation and is currently on follow up with no such episode of dyspnoea.

scholarly journals Effects of polymyxin B on clinical signs, serum TNF-α, haptoglobin and plasma lactate concentrations in experimental endotoxaemia in sheep

2018 ◽  
Vol 62 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Ali Hajimohammadi ◽  
Khalil Badiei ◽  
Parviz Kheibari ◽  
Meherdad Pourjafar ◽  
Aliasghar Chalmeh
Keyword(s):  
Intravenous Administration ◽  
Clinical Signs ◽  
Polymyxin B ◽  
Positive Control ◽  
Positive Control Group ◽  
Control Group ◽  
Plasma Lactate ◽  
Serum Haptoglobin ◽  
Tnf Α ◽  
Significant Difference

AbstractIntroductionThe experiment evaluated the effects of intravenous administration of polymyxin B on experimental endotoxaemia in sheep.Material and MethodsTwenty clinically healthy fat-tailed sheep were randomly divided into: a group treated with 6,000 U/kg of polymyxin B, a group at 12,000 U/kg, and positive and negative controls. Endotoxaemia was induced by intravenous administration of lipopolysaccharide (LPS) fromE.coliserotype O55:B5 at 0.5 μg/kg. polymyxin was infused intravenously along with 2.5 L of isotonic intravenous fluids at 20 mL/kg/h. The positive control group received LPS and 2.5 L of isotonic fluids, the negatives receiving just 2.5 L of isotonic fluids. Clinical signs were evaluated before and at 1.5, 3, 4.5, 6, 24, and 48 h after LPS administration. Blood was also sampled at the denoted hours and serum haptoglobin, tumour necrosis factor-α (TNF-α), and plasma lactate concentrations were assayed.ResultsThe serum concentration of TNF-α in the positive control group increased significantly up to 48 h after LPS administration. The concentration of TNF-α was significantly different from those of the polymyxin B and positive control groups from 3 to 48 h; also, the concentrations of haptoglobin at different times in the polymyxin groups were lower than those of the positive control group and were significant at hours 3 to 48 (P < 0.05). Following the LPS administration, haptoglobin and TNF-α concentrations changed without significant difference between the two polymyxin B groups.ConclusionPolymyxin B (6,000 U/kg) restrained blood lactate concentrations. Furthermore, it significantly improved the clinical signs in endotoxaemic animals, including rectal temperature and heart and respiratory rates. Polymyxin B may be an antiendotoxic in fat-tailed sheep.

scholarly journals Assessing the Risk of Nephrotoxicity Associated With Non-renally Adjusted Intravenous Polymyxin B Compared with Traditional Dosing

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S299-S300
Author(s):  
Bejoy Maniara ◽  
Thien-Ly Doan ◽  
Lauren Healy
Keyword(s):  
Ascorbic Acid ◽  
Chart Review ◽  
Potential Role ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Polymyxin B ◽  
Respiratory Arrest ◽  
Chi Square ◽  
Chi Square Test

Abstract Background Prior data states that polymyxin B is renally cleared and thus required renal adjustments, however newer data suggests that polymyxin B undergoes non-renal clearance. With more aggressive dosing, potential for increased nephrotoxicity is of concern. This study aims to determine whether time to acute kidney injury (AKI) differs between renally adjusted and non-adjusted doses of intravenous (IV) polymyxin B. Secondary objectives aim to evaluate incidence of AKI, length of stay (LOS), adverse reactions, and potential role of ascorbic acid in decreasing nephrotoxicity. Methods This retrospective chart review compared time to AKI in patients receiving renally adjusted and non-adjusted IV polymyxin B between Jan 2012 and Nov 2016. This study included patients who are at least 18 years old, received IV polymyxin B, and have creatinine clearance below 80 mL/minute. Patients were excluded if they had AKI (RIFLE criteria), received renal replacement therapy, or are pregnant prior to receipt of IV polymyxin B. Fine and Gray’s model for competing risks was used to predict the cumulative incidence function of AKI. Descriptive statistics, two-sample t-test, and Chi-square test were used as appropriate. Results Of the 132 patients screened, 54 met inclusion criteria (23 in the renally adjusted vs. 31 in the non-adjusted group). There was no statistical association between dosing type and time to AKI (P = 0.13). Incidence of nephrotoxicity was higher in the renally adjusted vs. non-adjusted groups (21.7% vs. 6.5% respectively). Mortality was higher in the renally adjusted vs. non-adjusted groups (17.4% vs. 6.5% respectively). LOS was greater in the renally adjusted vs. non-adjusted groups (16 vs. 14 days respectively, P = 0.26). All patients in the study received concomitant nephrotoxic agents (e.g., vancomycin, aminoglycosides). Ascorbic acid use was infrequent but, in the 4 patients who did receive it, none developed AKI. No difference in neurotoxicity, respiratory arrest, Clostridium difficile infections was seen. Conclusion No significant association between IV polymyxin B dosing type and time to AKI was found. Incidence of AKI, LOS, and mortality was higher in the renally adjusted group compared with the non-adjusted group. Ascorbic acid may mitigate the nephrotoxic potential of IV polymyxin B, but further studies are needed. Disclosures All authors: No reported disclosures.

Respiratory Arrest And Polymyxin B

JAMA ◽  
1966 ◽  
Vol 196 (12) ◽  
pp. 1097
Author(s):  
Oscar Swineford
Keyword(s):  
Polymyxin B ◽  
Respiratory Arrest

Effects of intravenous administration of polymyxin B in neonatal foals with experimental endotoxemia

2013 ◽  
Vol 243 (6) ◽  
pp. 874-881 ◽  
Author(s):  
David M. Wong ◽  
Brett A. Sponseller ◽  
Cody J. Alcott ◽  
Prince N. Agbedanu ◽  
Chong Wang ◽  
...  
Keyword(s):  
Intravenous Administration ◽  
Polymyxin B ◽  
Experimental Endotoxemia

Studies on the Fungal Pathogen of Dutch Elm Disease

1981 ◽  
Vol 39 ◽  
pp. 400-401
Author(s):  
H.M. Mazzone ◽  
G. Wray ◽  
R. Zerillo
Keyword(s):  
Fungal Pathogen ◽  
Fungal Growth ◽  
Polymyxin B ◽  
The United States ◽  
Dutch Elm Disease ◽  
Effective Control ◽  
Sabouraud Agar ◽  
Total Inhibition ◽  
Zones Of Inhibition ◽  
Control Plate

The fungal pathogen of the Dutch elm disease (DED), Ceratocystis ulmi (Buisman) C. Moreau, has eluded effective control since its introduction in the United States more than sixty years ago. Our studies on DED include establishing biological control agents against C. ulmi. In this report we describe the inhibitory action of the antibiotic polymyxin B on the causal agent of DED.In screening a number of antibiotics against C. ulmi, we observed that filter paper discs containing 300 units (U) of polymyxin B (Difco Laboratories) per disc, produced zones of inhibition to the fungus grown on potato dextrose agar or Sabouraud agar plates (100mm x 15mm), Fig. 1a. Total inhibition of fungal growth on a plate occurred when agar overlays containing fungus and antibiotic (polymyxin B sulfate, ICN Pharmaceuticals, Inc.) were poured on the underlying agar growth medium. The agar overlays consisted of the following: 4.5 ml of 0.7% agar, 0.5 ml of fungus (control plate); 4.0 ml of 0.7% agar, 0.5 ml of fungus, 0.5 ml of polymyxin B sulfate (77,700 U). Fig. 1, b and c, compares a control plate and polymyxin plate after seven days.

Intravenous administration of furosemide in heart failure

JAMA ◽  
1967 ◽  
Vol 200 (10) ◽  
pp. 824-829 ◽  
Author(s):  
M. Davidov
Keyword(s):  
Heart Failure ◽  
Intravenous Administration
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