title: Salvage treatment of pneumonia and initial treatment of tracheobronchitis caused by multidrug-resistant Gram-negative bacilli with inhaled polymyxin B.
abstract: Systemic colistin has shown efficacy against multidrug-resistant Pseudomonas aeruginosa and Acinetobacter spp., but it has presented poor results in pneumonia. Aerosolized polymyxin in cystic fibrosis patients has had good results. In this study, inhaled polymyxin B was used to treat respiratory infections by multidrug-resistant Gram-negative bacilli (MR-GNBs). Nineteen patients were treated with inhaled polymyxin B: 14 pneumonia, most of which had previously failed treatment with intravenous polymyxin B, and 5 tracheobronchitis. Inhaled polymyxin B was given at the dose of 500,000 IU twice a day after an aerosolized beta(2)-agonist. In pneumonia, inhaled and intravenous polymyxin B was given together. Median age was 69 years; 89% were in the intensive care unit. Sixteen infections (84%) were caused by P. aeruginosa. Klebsiella pneumoniae, Alcaligenes xylosoxidans, and Burkholderia sp. caused one infection each. In the 14 pneumonia cases, median of previous use of intravenous polymyxin B was 20 days (range, 0-32). Inhaled polymyxin B was used for a mean of 14 days (range, 4-25). Cure occurred in 10 (53%) patients, improvement in 8 (42%), and failure in 1. Nine patients died during hospitalization (all with pneumonia). Adverse events occurred in 4 patients without interruption of inhalation. This is the largest report using inhaled polymyxin B to treat nosocomial pneumonia by MR-GNB that had failed intravenous polymyxin B. It was also effective alone in P. aeruginosa tracheobronchitis.
authors.affiliation: Division of Infectious Diseases, Hospital São Luiz, São Paulo, 04506, Brazil.
authors.forename: Graziella H
authors.initials: GH
authors.lastname: Pereira
authors.forename: Patrícia R
authors.initials: PR
authors.lastname: Muller
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001991:Bronchitis / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology; D011112:Polymyxin B / Q000008:administration & dosage*; D016879:Salvage Therapy
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B