JAC Advance Access originally published online on July 21, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(2):566-569; doi:10.1093/jac/dkh369
JAC vol.54 no.2 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.
Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infections
1 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; 2 Department of Medicine, Division of Infectious Diseases, University of Rochester Medical Center, New York, USA; 3 Clinical Microbiology Service, Department of Pathology, College of Physicians and Surgeons, New York, USA; 4 Department of Pharmacy, New York Presbyterian Hospital, Columbia University Medical Center, New York, USA
* Corresponding authors. Tel: +1-212-305-7185; Fax: +1-212-305-7290; Email: mes52{at}columbia.edu and chk9005{at}nyp.org
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.
Patients and 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.
Keywords: RTIs , multidrug resistance , polymyxins
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