Polymyxin B Sulfate (polymyxin B sulfate)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Polymyxin B is a polymyxin antibiotic that is structurally and pharmacologically related to colistin.
Polymyxin B is a polymyxin antibiotic.
Polymyxin B sulfate is used for the treatment of serious infections, including infections of the urinary tract, meninges, or bloodstream, caused by susceptible gram-negative bacteria (e.g., Pseudomonas aeruginosa, Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Haemophilus influenzae). The drug also is used in the treatment of respiratory tract infections+ caused by susceptible gram-negative bacteria (e.g., Ps. aeruginosa, Acinetobacter baumannii+). Although other less toxic anti-infectives (e.g., fluoroquinolones, aminoglycosides, third generation cephalosporins, extended-spectrum penicillins, carbapenems) usually are the drugs of choice for most gram-negative bacterial infections, polymyxin B may be indicated when these drugs are ineffective or contraindicated, especially for serious infections caused by multidrug-resistant Ps. aeruginosa or A. baumannii.
Generic name: polymyxin B sulfate
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Polymyxin B Sulfate
Indications
The following indications are listed for Polymyxin B Sulfate:
- Bacterial Sepsis
- Bacterial Urinary Tract Infection
- H. Influenzae Meningitis
Also known as: Bacteremia With Sepsis, Bacterial Septicemia, H. Flu Meningitis, Haemophilus Influenzae Meningitis, Influenzae Bacillus Meningitis, Meningitis Due To Haemophilus Influenzae, Meningitis Due To Hemophilus Influenzae, Pfeiffer's Bacillus Meningitis.
Dosing
Dosage of polymyxin B sulfate usually is expressed in terms of polymyxin B activity (units of polymyxin B). Dosage of the drug also may be expressed as mg of polymyxin B base. Each mg of polymyxin B is equivalent to 10,000 units of polymyxin B.
Potency and dosage of polymyxin B sulfate are expressed in terms of polymyxin B activity (units of polymyxin B).
Dosage of polymyxin B should be decreased in patients with renal impairment. Serum polymyxin B concentrations should be monitored and IV or IM dosage adjusted to maintain desired serum concentrations of the drug.
Various dosage regimens have been recommended for use of polymyxin B in patients with renal impairment; however, these regimens are not well established and are not based on pharmacokinetic data from patients with renal impairment.
It has been recommended that patients with creatinine clearances of 30-80 mL/minute receive an IV loading dose of polymyxin B of 2.5 mg/kg on the first day of treatment followed by 1-1.5 mg/kg daily and that those with creatinine clearances less than 25-30 mL/minute receive these doses once every 2-3 days. For anuric patients, some clinicians have recommended an IV loading dose of 2.5 mg/kg followed by 1-1.5 mg/kg given once every 5-7 days.
Alternatively, it has been suggested that patients with creatinine clearances greater than 20 mL/minute receive 75-100% of the usual daily dose in 2 divided doses every 12 hours, those with creatinine clearances of 5-20 mL/minute receive 50% of the usual daily dose in 2 divided doses every 12 hours, and those with creatinine clearances less than 5 mL/minute receive 30% of the usual daily dose every 12-18 hours. Some clinicians have used 75% of the usual daily dose in those with creatinine clearances 20-50 mL/minute and 33% of the usual daily dose in those with creatinine clearances less than 20 mL/minute.
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Drug interactions
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There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
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There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
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There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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The safety of polymyxin B sulfate in pregnant women has not been established.
Some clinicians state that polymyxin B should not be used during pregnancy, except in rare situations when other appropriate anti-infectives cannot be used.
If use of the fixed-combination solution for irrigation containing polymyxin B sulfate and neomycin sulfate is being considered for a pregnant woman, the woman should be informed of the potential hazard to the fetus. Aminoglycosides cross the placenta and there have been reports of complete, irreversible, bilateral congenital deafness in children whose mothers received an aminoglycoside (i.e., streptomycin) during pregnancy.
Animal reproduction studies have not been performed with polymyxin B sulfate. It is not known whether ophthalmic preparations containing polymyxin B sulfate can cause fetal harm when administered to pregnant women.
Fixed-combination ophthalmic preparations of polymyxin B sulfate and bacitracin zinc or polymyxin B sulfate, neomycin sulfate, and either bacitracin zinc or gramicidin should be used during pregnancy only if clearly needed.
Because trimethoprim may interfere with folic acid metabolism, fixed-combination ophthalmic preparations containing polymyxin B sulfate and trimethoprim sulfate should be used during pregnancy only if potential benefits justify potential risks to the fetus.
Fixed-combination ophthalmic preparations containing polymyxin B sulfate, other anti-infectives (i.e., neomycin sulfate, bacitracin zinc), and a corticosteroid (i.e., dexamethasone, hydrocortisone, hydrocortisone acetate) should be used during pregnancy only if potential benefits justify potential risks to the fetus.
Fixed-combination otic preparations containing polymyxin B sulfate, neomycin sulfate, and hydrocortisone should be used during pregnancy only if potential benefits justify potential risks to the fetus.
Fixed-combination ophthalmic preparations containing polymyxin B sulfate and other anti-infectives (i.e., bacitracin zinc, gramicidin, neomycin sulfate, trimethoprim sulfate) should be used with caution in nursing women.
Fixed-combination ophthalmic preparations containing polymyxin B sulfate, neomycin sulfate, and dexamethasone should be used with caution in nursing women.
The manufacturers of fixed-combination ophthalmic preparations containing polymyxin B sulfate, neomycin sulfate, bacitracin zinc, and hydrocortisone or hydrocortisone acetate state that a decision should be made whether to discontinue nursing or the ophthalmic preparation, taking into account the importance of the drug to the woman.
Fixed-combination otic preparations containing polymyxin B sulfate, neomycin sulfate, and hydrocortisone should be used with caution in nursing women.
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ICD codes
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Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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