With an increase in infectious diseases, the overall consumption of antibiotics has enormously increased. However, antibiotics are not indicated in the majority of cases and antibiotic utilization is misused leading to antimicrobial resistance. Microorganisms like gram-negative Enterobacteriaceae have developed resistance to various antibiotics leading to decreased therapeutic options available. Antibiotics like polymyxins are reintroduced for the treatment of gram-negative organisms, and although it has produced significant clinical outcomes, very limited data is available regarding the cardiovascular complications of the drug. Here we report 2 cases of polymyxin-induced hypotension, to the best of our knowledge we believe that it is rare and is caused due to toxicity of the drug. Polymyxins are reintroduced as a last resort of drugs with a rise in infections due to gram-negative bacteria and the lack of new antibiotics to combat them
Polymyxins are reintroduced as a last resort of drugs with a rise in infections due to gram-negative bacteria and the lack of new antibiotics to combat them. These are groups of polypeptides discovered from different species of Paenibacillus polymyxa (previously Bacillus polymyxa) in 1947. These are the bactericidal drugs that bind to the lipopolysaccharides and phospholipids of the outer cell member of gram-negative bacteria. Polymyxins interact with lipopolysaccharides resulting in increased permeability of the bacterial cell member causing cytoplasmic leakage and resulting in cell death. Various studies have demonstrated the mechanism of polymyxin resistance limiting the usage of the drug.
The spectrum of activity includes various gram-negative organisms including Klebsiella spp., Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter spp. Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Yersinia pseudotuberculosis, Haemophilus influenzae, Pasteurella spp., Bordetella pertussis, Legionella pneumophila. The majority of nosocomial pathogens are susceptible. Some of the organisms have acquired intrinsic resistance to polymyxins which include Burkholderia spp., Proteus spp., Providencia spp., Morganella morganii, and Serratia spp. Additionally, Brucella spp., Neisseria spp., and Chromobacterium spp. isolates are also resistant. The recommended loading dose of polymyxin B is 2.0 mg/kg-2.5 mg/kg over 1-hour infusion The maintenance dose includes 1.125 mg-1.5 mg ( equivalent to 12,500 IU/kg-15,000 IU/kg of total body weight every 12 hours over 1-hour infusion. Earlier findings illustrate that nephrotoxicity and neurotoxicity are the most common side effects, associated with polymyxin B but cardiovascular toxicity is rare to the best of our knowledge. We report two cases of polymyxin-induced hypotension in our health care.
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