Optimizing Clinical Use of Polymyxin B

Launched by RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY · Feb 10, 2016

Keywords

ClinConnect Summary

Multidrug-resistant (MDR) Gram-negative 'superbugs' are rapidly spreading around the world, and polymyxin B and colistin (polymyxin E) are often the only effective antibiotics. Since polymyxin B was released in the 1950s, its pharmacokinetics, pharmacodynamics, toxicodynamics (PK/PD/TD) have never been defined. Recent pharmacological research on polymyxins has predominantly focused on colistin methanesulfonate (CMS, an inactive prodrug of colistin) and demonstrates that CMS has significant limitations. Thus, polymyxin B is increasingly being viewed as the preferred polymyxin. Unfortunately,...

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Eligibility criteria

• Inclusion Criteria:
• • 1. Patient of 18 years of age or older
• • 2. Expectation of hospitalization and receipt of polymyxin B of ≥ 48 hours
• • 3. Receipt of intravenous polymyxin B for treatment of bacteremia and/or urinary tract infection and/or respiratory tract infection (including tracheobronchitis) or sepsis
• • 4. Provision of written informed consent by the patient or by the patient's health care proxy if the patient cannot give consent
• • 5. Adequate venous access to enable collection of blood for determination of concentrations of polymyxin B and co-administered antibiotics
• Exclusion Criteria:
• • 1. Age \<18 years
• • 2. Currently incarcerated
• • 3. Concomitant use of polymyxin B delivered directly into the respiratory tract
• • 4. Cystic fibrosis
• • 5. Known allergy to CMS/colistin or polymyxin B
• • 6. Anticipated death within 48 h of commencing polymyxin B therapy