Yes

Antibiotic, Irrigation; Antibiotic, Miscellaneous

Topical: Wound irrigation and bladder irrigation against Pseudomonas aeruginosa; used occasionally for gut decontamination

Parenteral use of polymyxin B has mainly been replaced by less toxic antibiotics; it is reserved for life-threatening infections caused by organisms resistant to the preferred drugs (eg, pseudomonal meningitis - intrathecal administration)

B

Concurrent use of neuromuscular blockers

Use with caution in patients with impaired renal function, (modify dosage); polymyxin B-induced nephrotoxicity may be manifested by albuminuria, cellular casts, and azotemia. Discontinue therapy with decreasing urinary output and increasing BUN; neurotoxic reactions are usually associated with high serum levels, often in patients with renal dysfunction. Avoid concurrent or sequential use of other nephrotoxic and neurotoxic drugs (eg, aminoglycosides). The drug's neurotoxicity can result in respiratory paralysis from neuromuscular blockade, especially when the drug is given soon after anesthesia or muscle relaxants. Polymyxin B sulfate is most toxic when given parenterally; avoid parenteral use whenever possible.

<1%: Facial flushing, neurotoxicity (irritability, drowsiness, ataxia, perioral paresthesia, numbness of the extremities, and blurring of vision); drug fever, urticarial rash, hypocalcemia, hyponatremia, hypokalemia, hypochloremia, pain at injection site, neuromuscular blockade, weakness, nephrotoxicity, respiratory arrest, anaphylactoid reaction, meningeal irritation with intrathecal administration

Symptoms of overdose include respiratory paralysis, ototoxicity, nephrotoxicity

Supportive care is indicated as treatment; ventilatory support may be necessary

Polymyxin may increase/prolong effect of neuromuscular blocking agents; aminoglycosides may increase polymyxin's risk of respiratory paralysis and renal dysfunction

Discard any unused solution after 72 hours. Incompatible with strong acids/alkalies, calcium, magnesium, cephalothin, cefazolin, chloramphenicol, heparin, penicillins.

Binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents

Absorption: Well absorbed from the peritoneum; minimal absorption from the GI tract (except in neonates) from mucous membranes or intact skin

Distribution: Minimal distribution into the CSF; crosses the placenta

Half-life: 4.5-6 hours, increased with reduced renal function

Time to peak serum concentration: I.M.: Within 2 hours

Elimination: Primarily as unchanged drug (>60%) in urine via glomerular filtration

Otic: 1-2 drops, 3-4 times/day; should be used sparingly to avoid accumulation of excess debris

Infants <2 years:

I.M.: Up to 40,000 units/kg/day divided every 6 hours (not routinely recommended due to pain at injection sites)

I.V.: Up to 40,000 units/kg/day by continuous I.V. infusion

Intrathecal: 20,000 units/day for 3-4 days, then 25,000 units every other day for at least 2 weeks after CSF cultures are negative and CSF (glucose) has returned to within normal limits

Children greater than or equal to 2 years and Adults:

I.M.: 25,000-30,000 units/kg/day divided every 4-6 hours (not routinely recommended due to pain at injection sites)

I.V.: 15,000-25,000 units/kg/day divided every 12 hours or by continuous infusion

Intrathecal: 50,000 units/day for 3-4 days, then every other day for at least 2 weeks after CSF cultures are negative and CSF (glucose) has returned to within normal limits

Total daily dose should not exceed 2,000,000 units/day

Bladder irrigation: Continuous irrigant or rinse in the urinary bladder for up to 10 days using 20 mg (equal to 200,000 units) added to 1 L of normal saline; usually no more than 1 L of irrigant is used per day unless urine flow rate is high; administration rate is adjusted to patient's urine output

Topical irrigation or topical solution: 500,000 units/L of normal saline; topical irrigation should not exceed 2 million units/day in adults

Gut sterilization: Oral: 15,000-25,000 units/kg/day in divided doses every 6 hours

Clostridium difficile enteritis: Oral: 25,000 units every 6 hours for 10 days

Ophthalmic: A concentration of 0.1% to 0.25% is administered as 1-3 drops every hour, then increasing the interval as response indicates to 1-2 drops 4-6 times/day

Dosing adjustment/interval in renal impairment:

Cl_cr 20-50 mL/minute: Administer 75% to 100% of normal dose every 12 hours

Cl_cr 5-20 mL/minute: Administer 50% of normal dose every 12 hours

Cl_cr <5 mL/minute: Administer 15% of normal dose every 12 hours

Neurologic symptoms and signs of superinfection; renal function (decreasing urine output and increasing BUN may require discontinuance of therapy)

Serum concentrations >5 mg/mL are toxic in adults

No information available to require special precautions

No effects or complications reported

Wound irrigation / bladder irrigation / gut sterilization / or I.V.: Immediately report numbness or tingling of mouth, tongue, or extremities; constant blurring of vision; increased nervousness or irritability; excessive drowsiness; or difficulty breathing.

Breast-feeding precautions: Consult prescriber if breast-feeding.

Parenteral use is indicated only in life-threatening infections caused by organisms not susceptible to other agents

Injection: 500,000 units (20 mL)

Solution (otic): 10,000 units of polymyxin B per mL in combination with hydrocortisone 0.5% solution (eg, Otobiotic®)

Suspension (otic): 10,000 units of polymixin B per mL in combination with hydrocortisone 1% and neomycin sulfate 0.5% (eg, PediOtic®)

Also available in a variety of other combination products for ophthalmic and otic use.