Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infections.
BACKGROUND
The treatment of infections caused by multidrug-resistant (MDR) Gram-negative organisms poses a therapeutic challenge. The use of polymyxin B has been resurrected specifically for this purpose.


METHODS
We retrospectively reviewed the clinical and microbiological efficacy, and safety profile of polymyxin B in the treatment of MDR Gram-negative bacterial infections of the respiratory tract. Twenty-five critically ill patients received a total of 29 courses of polymyxin B administered in combination with another antimicrobial agent.


RESULTS
Patients were treated with intravenous, and/or aerosolized polymyxin B. Mean duration of polymyxin B therapy was 19 days (range 2-57 days). End of treatment mortality was 21%, and overall mortality at discharge was 48%. Nephrotoxicity was observed in three patients (10%) and did not result in discontinuation of therapy.


CONCLUSIONS
Polymyxin B in combination with other antimicrobials can be considered a reasonable and safe treatment option for MDR Gram-negative respiratory tract infections in the setting of limited therapeutic options.
Department of Medicine, Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, 630 W. 168th Street, PH 8W-876, New York, NY 10032, USA. mes52@columbia.edu
Magdalena E
ME
Sobieszczyk
E Yoko
EY
Furuya
Christine M
CM
Hay
Preeti
P
Pancholi
Phyllis
P
Della-Latta
Scott M
SM
Hammer
Christine J
CJ
Kubin
D040981:Acinetobacter baumannii / Q000187:drug effects; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000421:Alcaligenes / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007275:Injections, Intravenous; D007674:Kidney Diseases / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D011112:Polymyxin B