Drug Detail:Polymyxin b (systemic, topical) (monograph) (Medically reviewed)
Drug Class:
Usual Adult Dose for Bacteremia
IM: 25,000 to 30,000 units/kg/day IM divided every 4 or 6 hours
IV: 15,000 to 25,000 units/kg/day IV divided every 12 hours
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of Pseudomonas aeruginosa
Uses:
- For the treatment of infections of the urinary tract and bloodstream due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious bacteremia due to susceptible strains of Enterobacter aerogenes or Klebsiella pneumoniae
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious urinary tract infections due to susceptible strains of Escherichia coli
Usual Adult Dose for Urinary Tract Infection
IM: 25,000 to 30,000 units/kg/day IM divided every 4 or 6 hours
IV: 15,000 to 25,000 units/kg/day IV divided every 12 hours
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of Pseudomonas aeruginosa
Uses:
- For the treatment of infections of the urinary tract and bloodstream due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious bacteremia due to susceptible strains of Enterobacter aerogenes or Klebsiella pneumoniae
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious urinary tract infections due to susceptible strains of Escherichia coli
Usual Adult Dose for Meningitis
Initial dose: 50,000 units intrathecally once a day for 3 to 4 days
Maintenance dose: 50,000 units intrathecally every other day
Duration of therapy: At least 2 weeks after CSF cultures are negative and sugar content normalizes
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of P aeruginosa
Uses:
- For the treatment of infections of the meninges due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious meningeal infections due to susceptible strains of Haemophilus influenzae
Usual Adult Dose for Ocular Infection
Ophthalmic:
- Topical: Instill 1 to 3 drops into the affected eye(s) every hour, increasing intervals as indicated by response
- Subconjunctival injection: Inject up to 100,000 units/day subconjunctivally
Comments:
- A concentration of 0.1% to 0.25% (10,000 to 25,000 units/mL) is recommended for topical use.
- Total systemic and ophthalmic instillation over 25,000 units/kg/day should be avoided.
Uses:
- Topically, for the treatment of infections of the eye due to susceptible strains of P aeruginosa
- Subconjunctivally, for the treatment of P aeruginosa infections of the cornea and conjunctiva
Usual Pediatric Dose for Bacteremia
Infants:
- IM: 25,000 to 40,000 units/kg/day IM divided every 4 or 6 hours
- IV: 15,000 to 40,000 units/kg/day IV divided every 12 hours
Children:
- IM: 25,000 to 30,000 units/kg/day IM divided every 4 or 6 hours
- IV: 15,000 to 25,000 units/kg/day IV divided every 12 hours
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of P aeruginosa
- In limited clinical trials, up to 45,000 units/kg/day IM has been used to treat preterm and newborn infants for sepsis due to P aeruginosa.
Uses:
- For the treatment of infections of the urinary tract and bloodstream due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious bacteremia due to susceptible strains of E aerogenes or K pneumoniae
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious urinary tract infections due to susceptible strains of E coli
Usual Pediatric Dose for Urinary Tract Infection
Infants:
- IM: 25,000 to 40,000 units/kg/day IM divided every 4 or 6 hours
- IV: 15,000 to 40,000 units/kg/day IV divided every 12 hours
Children:
- IM: 25,000 to 30,000 units/kg/day IM divided every 4 or 6 hours
- IV: 15,000 to 25,000 units/kg/day IV divided every 12 hours
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of P aeruginosa
- In limited clinical trials, up to 45,000 units/kg/day IM has been used to treat preterm and newborn infants for sepsis due to P aeruginosa.
Uses:
- For the treatment of infections of the urinary tract and bloodstream due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious bacteremia due to susceptible strains of E aerogenes or K pneumoniae
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious urinary tract infections due to susceptible strains of E coli
Usual Pediatric Dose for Sepsis
Infants:
- IM: 25,000 to 40,000 units/kg/day IM divided every 4 or 6 hours
- IV: 15,000 to 40,000 units/kg/day IV divided every 12 hours
Children:
- IM: 25,000 to 30,000 units/kg/day IM divided every 4 or 6 hours
- IV: 15,000 to 25,000 units/kg/day IV divided every 12 hours
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of P aeruginosa
- In limited clinical trials, up to 45,000 units/kg/day IM has been used to treat preterm and newborn infants for sepsis due to P aeruginosa.
Uses:
- For the treatment of infections of the urinary tract and bloodstream due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious bacteremia due to susceptible strains of E aerogenes or K pneumoniae
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious urinary tract infections due to susceptible strains of E coli
Usual Pediatric Dose for Meningitis
Children under 2 years:
- Initial dose: 20,000 units intrathecally once a day for 3 to 4 days OR 25,000 units intrathecally every other day
- Maintenance dose: 25,000 units intrathecally every other day
Children over 2 years:
- Initial dose: 50,000 units intrathecally once a day for 3 to 4 days
- Maintenance dose: 50,000 units intrathecally every other day
Duration of therapy: At least 2 weeks after CSF cultures are negative and sugar content normalizes
Comments:
- Recommended as the drug of choice in the treatment of infections due to susceptible strains of P aeruginosa
Uses:
- For the treatment of infections of the meninges due to susceptible strains of P aeruginosa
- When less potentially toxic agents are ineffective/contraindicated, for the treatment of serious meningeal infections due to susceptible strains of H influenzae
Renal Dose Adjustments
Renal Dysfunction:
- IM: Dose reduction recommended; however, no specific guidelines have been suggested.
- IV: Usual amount should be reduced from 15,000 units/kg downward.
Liver Dose Adjustments
Data not available
Precautions
US BOXED WARNINGS:
- APPROPRIATE USE: This drug should be administered IM, IV, and/or intrathecally only in hospitalized patients in order to provide continuous supervision by a physician.
- NEPHROTOXICITY: Renal function should be carefully determined; reduced dose should be used in patients with renal damage and nitrogen retention. Albuminuria, cellular casts, and azotemia are generally seen in patients with nephrotoxicity due to this drug. Decreasing urine output and increasing BUN are indications for discontinuing this drug.
- NEUROTOXICITY: Neurotoxic reactions may be shown by irritability, weakness, drowsiness, ataxia, perioral paresthesia, numbness of extremities, and blurring of vision; such reactions are generally associated with high serum levels found in patients with impaired renal function and/or nephrotoxicity.
- CONCOMITANT THERAPY: Coadministration with or sequential use of other neurotoxic and/or nephrotoxic agents (especially bacitracin, streptomycin, neomycin, kanamycin, gentamicin, tobramycin, amikacin, cephaloridine, paromomycin, viomycin, colistimethate [colistin]) should be avoided.
- NEUROMUSCULAR BLOCKADE: The neurotoxicity of this drug can lead to respiratory paralysis from neuromuscular blockade, particularly when administered soon after anesthesia and/or muscle relaxants.
- USE IN PREGNANCY: Safety of this drug has not been established in human pregnancy.
CONTRAINDICATIONS:
Prior history of hypersensitivity reactions to polymyxins
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- For hospital use only if prescribed for IM, IV, and/or intrathecal administration.
- Routine IM administration not recommended due to severe pain at injection sites (especially in infants and children).
- In meningeal infections, administer this drug only by the intrathecal route.
Storage requirements:
- Before reconstitution: Store at 20C to 25C (68F to 77F); store in carton until use to protect from light.
- After reconstitution: Store in refrigerator between 2C and 8C (36F and 46F) up to 72 hours.
Reconstitution/preparation techniques:
- The manufacturer product information should be consulted.
IV compatibility:
- Compatible: 5% Dextrose Injection
Monitoring:
- General: Drug levels in blood (frequently during parenteral therapy)
- Renal: Renal function (before and frequently during parenteral therapy)
Patient advice:
- Avoid missing doses and complete the entire course of therapy.
- Consult physician without delay if watery and bloody stools (with or without stomach cramps and fever) develop.
Frequently asked questions
- How long does it take for neomycin, polymyxin b and hydrocortisone ear drops to work?
- Can I use expired neomycin and polymyxin b sulfates, dexamethasone ophthalmic?
