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polymyxin B
generic
Black Box Warnings .
Appropriate Use
IM or intrathecally-administered polymyxin B should only be given to hospitalized pts in order to provide constant physician supervision
Nephrotoxicity
s/sx includes albuminuria, cellular casts, azotemia; carefully determine renal fxn and reduce dose in pts w/ renal damage and nitrogen retention; avoid concurrent or sequential nephrotoxic agents; D/C polymyxin B if diminishing urine output and rising BUN
Neurotoxicity
manifested by irritability, weakness, drowsiness, ataxia, perioral paresthesia, extremity numbness, blurred vision; may result in respiratory paralysis from neuromuscular blockade, esp. when given soon after anesthesia and/or muscle relaxants; neurotoxicity usually assoc. w/ high serum levels in pts w/ renal impairment or nephrotoxicity; avoid concurrent or sequential neurotoxic and/or nephrotoxic agents
Pregnancy
safety has not been established
Adult Dosing .
Dosage forms: INJ
infections, severe bacterial
- [12,500-15,000 units/kg/dose IV q12h]
- Start: 20,000-25,000 units/kg/dose IV x1; Max: 30,000 units/kg/day IM; Alt: 25,000-30,000 units/kg/day IM divided q4-6h; Info: for infections due to multi-drug resistant gram-negative bacteria; use ABW to calculate dose; consider using adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts, max 2 million units/day
meningitis, bacterial
- [50,000 units intrathecally q24h]
- Info: for infections due to multi-drug resistant gram-negative bacteria; not 1st-line agent; give w/ IV polymyxin B or IV colistimethate
pneumonia, hospital-acquired or ventilator-assoc. (off-label)
- [25,000-30,000 units/kg/day IV divided q12h x7days]
- Info: may extend duration based on clinical response; refer to IDSA guidelines; consider using adjusted wt of IBW + 0.4 x (ABW - IBW) in obese pts, max 2 million units/day
ventriculitis, bacterial (off-label)
- [50,000 units intracerebroventricularly q24h]
- Info: for infections due to multi-drug resistant gram-negative bacteria; not 1st-line agent; give w/ IV polymyxin B or IV colistimethate
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
infections, severe bacterial
- [<2 yo]
- Dose: up to 40,000 units/kg/day IV divided q12h; Max: 45,000 units/kg/day; Alt: up to 40,000 units/kg/day IM divided q4-6h; Info: for infections due to multi-drug resistant gram-negative bacteria
- [2 yo and older]
- Dose: 15,000-25,000 units/kg/day IV divided q12h; Max: 25,000 units/kg/day IV, 30,000 units/kg/day IM; Alt: 25,000-30,000 units/kg/day IM divided q4-6h; Info: for infections due to multi-drug resistant gram-negative bacteria
meningitis, bacterial
- [<2 yo]
- Dose: 25,000 units intrathecally qod; Info: for infections due to multi-drug resistant gram-negative bacteria; may start 20,000 units intrathecally qd x3-4 days; cont. qod tx for >2wk after negative CSF cultures
- [2 yo and older]
- Dose: 50,000 units intrathecally qd x3-4 days, then 50,000 units intrathecally qod; Info: for infections due to multi-drug resistant gram-negative bacteria; cont. tx for >2wk after negative CSF cultures
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]