IntramuscularBacteraemia, Urinary tract infectionsAdult: 25,000-30,000 units/kg daily in divided doses given at 4- or 6-hour intervals.
Child: Infants Up to 40,000 units/kg daily; Children Same as adult dose.
IntrathecalMeningitisAdult: 50,000 units once daily for 3-4 days, then 50,000 units once every other day for at least 2 weeks after CSF cultures are negative.
Child: <2 years 20,000 units once daily for 3-4 days or 25,000 units once every other day, then continue treatment with 25,000 units once every other day for at least 2 weeks after CSF cultures are negative; ≥2 years Same as adult dose.
IntravenousBacteraemia, Urinary tract infectionsAdult: 15,000-25,000 units/kg daily in 2 divided doses 12 hourly via IV infusion. Max: 25,000 units/kg daily.
Child: Infants Up to 40,000 units/kg daily via IV infusion; Children Same as adult dose.
OphthalmicBacterial ophthalmic infectionsAdult: For infections caused by susceptible strains of Pseudomonas aeruginosa: As 0.1-0.25% (10,000-25,000 units/mL) reconstituted solution: 1-3 drops hourly; increase intervals based on response.
SubconjunctivalConjunctival infection, Corneal infectionAdult: For infections caused by susceptible strains of Pseudomonas aeruginosa: Up to 100,000 units daily. Max total dose (when used in combination with topical preparation of polymyxin B): 25,000 units/kg daily.
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Intravenous; Intramuscular:
Dose reduction may be required.
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IV infusion: Reconstitute vial labelled as 500,000 units with 300-500 mL of dextrose 5% in water solution to make a concentration of 1,000-1,667 units/mL. IM: Reconstitute vial labelled as 500,000 units with 2 mL NaCl 0.9% solution, sterile water for inj or procaine hydrochloride 1% inj to make a concentration of 250,000 units/mL. Intrathecal: Reconstitute vial labelled as 500,000 units with 10 mL NaCl 0.9% solution to make a concentration of 50,000 units/mL. Ophthalmic/Subconjunctival: Reconstitute vial labelled as 500,000 units with 20-50 mL sterile water for inj or NaCl 0.9% solution to make a concentration of 10,000-25,000 units/mL.
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Rapidly inactivated by strong acids and alkalis. Incompatible with many other drugs including ampicillin, cefazolin, chloramphenicol sodium succinate, amphotericin B, chlorothiazide sodium, and heparin sodium.
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Hypersensitivity to polymyxin B.
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Patient with neuromuscular disease (e.g. myasthenia gravis). IM administration is not recommended for routine use, particularly in infants and children. Avoid concurrent or sequential use of other neurotoxic or nephrotoxic agents with polymyxin B. Renal impairment. Children. Pregnancy (safety is not established) and lactation.
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Significant: Nephrotoxicity (e.g. albuminuria, azotaemia, cylindruria), neurotoxicity (e.g. irritability, weakness, drowsiness, ataxia, circumoral and stocking-glove pattern paraesthesias, numbness in extremities, blurred vision); severe pain at inj site (IM), thrombophlebitis at infusion site (IV).
General disorders and administration site conditions: Fever.
Skin and subcutaneous tissue disorders: Urticaria, hyperpigmentation.
Potentially Fatal: Clostridioides difficile-associated diarrhoea and pseudomembranous colitis.
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Ophth/Otic/Topical: C (FDA Pregnancy Category C applies to polymyxin B in combination w/ other drugs.)
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Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor renal function before and during treatment; serum polymyxin B concentration during treatment. Assess for signs or symptoms of neurotoxicity and superinfection.
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Increased risk of respiratory depression with neuromuscular blocking agents (e.g. tubocurarine chloride, suxamethonium, gallamine triethiodide, decamethonium bromide) and other neurotoxic agents (e.g. sodium citrate). Increased risk of neurotoxicity or nephrotoxicity with other neurotoxic or nephrotoxic drugs, particularly bacitracin, streptomycin, neomycin, kanamycin, gentamicin, tobramycin, amikacin, paromomycin, cefaloridine, viomycin, and colistimethate sodium/colistin.
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Description:
Mechanism of Action: Polymyxin B, a polymyxin antibiotic, binds to membrane phospholipids, alters permeability and damages the bacterial cytoplasmic membrane causing leakage of intracellular constituents.
Pharmacokinetics:
Absorption: Time to peak plasma concentration: Within 2 hours (IM).
Distribution: Widely distributed in the body; extensively bound to cell membranes in the tissues. Plasma protein binding: Approx 60%.
Excretion: Via urine (<1% as unchanged drug within 1st 12 hours; up to 60% as unchanged drug as treatment continues). Elimination half-life: 10.1-13.6 hours.
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Intact vials: Store between 15-30°C. Protect from light. Reconstituted solution: Store between 2-8°C. Any unused solution must be discarded after 72 hours.
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S01AA18 - polymyxin B ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
J01XB02 - polymyxin B ; Belongs to the class of polymyxins. Used in the systemic treatment of infections.
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Anon. Polymyxin B Sulfate (Systemic, Topical). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 24/05/2024. Anon. Polymyxin B. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 08/05/2024. Buckingham R (ed). Polymyxin B Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/05/2024. POLY-MxB for Injection U.S.P. 500,000 Units Lyophilized (Pahang Pharmacy Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 08/05/2024. Polymyxin B Injection, Powder, Lyophilized, for Solution (Athenex Pharmaceutical Division, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 08/05/2024. Polymyxin B. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 08/05/2024. Polymyxin B. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 08/05/2024.
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