Polymyxin B Sulphate

Indications
 Parenteral
Susceptible infections
Adult: IV admin: 15,000-25,000 u (1.5-2.5 mg)/kg/day in divided doses 12 hrly by IV infusion. IM admin: 25,000-30,000 u/kg/day in divided doses 4-6 hrly. Total dose should not exceed 2,000,000 u/day.
Renal impairment: Reduce dose. Max: 15,000 units/kg daily.
Ophthalmic
Ocular infections
Adult: As a 0.1% eye solution/ointment with neomycin and dexamethasone. Eye drops: instill 1-2 drops 4-6 times daily into the affected eye(s) in mild disease, may be used hrly in severe disease. Eye ointment: apply a small amount into the conjunctival sac(s) of the affected eye(s) up to 3-4 times daily.
Otic/Aural
Otic infections
Adult: As an otic suspension containing 3.5 mg neomycin base, polymyxin B equivalent to 10,000 polymyxin B units and hydrocortisone 10 mg/ml of the suspension: instill 4 drops into the affected ear canal 3-4 times daily for up to 10 days.
Child: As an otic suspension containing 3.5 mg neomycin base, polymyxin B equivalent to 10,000 polymyxin B units and hydrocortisone 10 mg/ml of the suspension: instill 3 drops into the affected ear canal 3-4 times daily for up to 10 days.
Topical/Cutaneous
Skin infections
Adult: Apply a 0.1% soln or oint onto affected area in combination with other drugs.

Special Populations: Reduce dose in patients with renal impairment.
Contraindications
 Hypersensitivity, perforated ear drums.
Warnings / Precautions
 Application to large areas of broken skin. Renal impairment; monitor renal function. Pregnancy, lactation. Monitor serum concentrations of polymyxins in patients receiving parenteral therapy.
Adverse Reactions
 Dizziness, paraesthesia, muscle weakness, ataxia, confusion, drowsiness, psychoses, convulsions, coma. Neuromuscular blockade characterized by respiratory paralysis and apoea. Acute interstitial nephritis; nausea, vomiting, electrolyte imbalance. Topical: Hypersensitivity eg, macular rashes, risk of systemic toxicity if applied to large areas of broken skin. Otic: Ototoxicity, stinging and burning sensation. Ophthalmic: Hypersensitivity, itching, redness and oedema of conjunctiva and eye lid. Intrathecal: Meningeal irritation.
Potentially Fatal: Nephrotoxicity (higher doses and preexisting failure), neurotoxicity; resp failure; anaphylaxis.
Drug Interactions
 May enhance action of neuromuscular blockers. Increased risk of ototoxicity and nephrotoxicity when used with vancomycin.
Potentially Fatal: Potentiates nephrotoxicity produced by cefalotin and aminoglycosides.
See Below for More polymyxin b Drug Interactions
Mechanism of Actions
 Polymyxin B disrupts the bacterial cytoplasmic membrane of mostly gm-ve organisms allowing leakage of intracellular constituents by binding to membrane phospholipids.
Absorption: Minimal from GIT except in neonates. Peak plasma concentrations after 2 hr (IM).
Distribution: Widely distributed; extensively bound to cell membranes in the tissues.
Excretion: Excreted mainly by kidneys. Urine (>60% as unchanged drug); 6 hr (elimination half-life).
Storage Conditions
 Ophthalmic: Store at 2-25°C. Otic/Aural: Store at 15-25°C. Topical/Cutaneous: Store at 15-30°C.
ATC Classification
 J01XB02 - polymyxin B ; Belongs to the class of polymyxins. Used in the systemic treatment of infections.
A07AA05 - polymyxin B ; Belongs to the class of antibiotics. Used in the treatment of intestinal infections.
S01AA18 - polymyxin B ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
S02AA11 - polymyxin B ; Belongs to the class of antiinfectives used in the treatment of ear infections.
S03AA03 - polymyxin B ; Belongs to the class of antiinfectives used in ophthalmologic and otologic preparations.
Storage
 Ophthalmic: Store at 2-25°C. Otic/Aural: Store at 15-25°C. Topical/Cutaneous: Store at 15-30°C.
Available As
  • Polymyxin B Sulphate 0.5 million units
  • Polymyxin B Sulphate 10000 iu
  • Polymyxin B Sulphate 10000 units
  • Polymyxin B Sulphate 500 iu
  • Polymyxin B Sulphate 5000 iu
  • Polymyxin 5000 iu
  • Polymyxin B Sulphate 5000 units
  • Polymyxin B Sulphate 500000 iu

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