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JAC Advance Access published online on July 21, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh369
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received March 22, 2004
Revised June 14, 2004
Accepted June 19, 2004

Brief report

Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infections

Magdalena E. Sobieszczyk 1*, E. Yoko Furuya 1, Christine M. Hay 2, Preeti Pancholi 3, Phyllis Della-Latta 3, Scott M. Hammer 1, Christine J. Kubin 4*

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, USA
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 Medicine, Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, 630 W. 168th Street, PH 8W-876, New York, NY 10032, USA; Department of Pharmacy, New York Presbyterian Hospital, Columbia University Medical Center, New York, USA

* To whom correspondence should be addressed. E-mail: chk9005{at}nyp.org.


  Abstract

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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