PMB
Generic Name
Polymyxin B Injection
Manufacturer
Various generic manufacturers (e.g., Fresenius Kabi, Sandoz)
Country
Multiple countries
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| pmb 5 lac injection | ৳ 400.00 | N/A |
Description
Overview of the medicine
Polymyxin B is an antibiotic used to treat severe infections caused by Gram-negative bacteria, particularly those resistant to other antibiotics. It works by disrupting the bacterial cell membrane, leading to cell death. It is often considered a 'last-resort' antibiotic for multi-drug resistant (MDR) infections.
Uses & Indications
Dosage
Adults
Intravenous: 15,000 to 25,000 units/kg/day, divided into 2 doses, given over 60-90 minutes. Maximum 2,000,000 units/day. Intrathecal: 50,000 units once daily for 3-4 days, then 50,000 units every other day for at least 2 weeks after CSF cultures are negative.
Elderly
Dosage adjustment may be necessary based on renal function and overall health status; careful monitoring is recommended.
Renal_impairment
Significant dose reduction required. For CrCl 20-50 mL/min: 1.0-1.5 mg/kg every 12 hours. For CrCl < 20 mL/min: 1.0-1.5 mg/kg every 24-48 hours. Close monitoring of renal function is essential.
How to Take
Polymyxin B powder for injection should be reconstituted with sterile water for injection or 0.9% sodium chloride. For intravenous administration, the reconstituted solution must be further diluted and administered as a slow infusion over 60-90 minutes. Intramuscular injection should be deep. Intrathecal administration requires specialized technique.
Mechanism of Action
Polymyxin B is a cationic detergent that binds to the lipopolysaccharide (LPS) of the outer membrane of Gram-negative bacteria. This binding displaces essential cations (Ca++, Mg++), leading to increased permeability of the cell membrane, leakage of intracellular components, and ultimately cell death.
Pharmacokinetics
Onset
Rapid after intravenous administration.
Excretion
Primarily excreted renally (about 60% in 24-48 hours), some via bile. Not significantly removed by hemodialysis.
Half life
Approximately 4.3 to 6 hours (may be prolonged in renal impairment).
Absorption
Poorly absorbed from the gastrointestinal tract and mucous membranes. Systemic absorption occurs after parenteral (IV, IM, intrathecal) administration.
Metabolism
Minimal hepatic metabolism; primarily excreted unchanged.
Side Effects
Contraindications
- Known hypersensitivity to polymyxin B or any component of the formulation.
- Patients with pre-existing renal impairment, unless the benefits outweigh the risks and close monitoring is possible.
Drug Interactions
Cephalosporins, Penicillins
Antagonistic effects have been reported in some in vitro studies; clinical significance is unclear, but combination therapy generally aims for synergistic effects.
Aminoglycosides (e.g., Gentamicin, Amikacin)
Increased risk of nephrotoxicity and neurotoxicity (ototoxicity). Avoid concomitant use if possible or monitor closely.
Neuromuscular blocking agents (e.g., Vecuronium, Rocuronium)
Polymyxin B can potentiate and prolong neuromuscular blockade, leading to respiratory depression or apnea. Use with extreme caution and monitor respiratory function.
Other nephrotoxic drugs (e.g., NSAIDs, Cyclosporine, Amphotericin B)
Increased risk of renal damage. Monitor renal function frequently.
Storage
Store unopened vials at controlled room temperature (20-25°C / 68-77°F), protected from light. Reconstituted solutions should be stored in a refrigerator (2-8°C / 36-46°F) and used within their specified stability period.
Overdose
Symptoms of overdose include severe nephrotoxicity (acute renal failure), neurotoxicity (dizziness, ataxia, respiratory paralysis, apnea, peripheral neuropathy). Management is primarily supportive, including respiratory support if apnea occurs. Hemodialysis may be considered, but its effectiveness in removing polymyxin B from the body is uncertain.
Pregnancy & Lactation
Pregnancy Category C. Use in pregnancy only if the potential benefit outweighs the potential risk to the fetus. It is not known whether Polymyxin B is excreted in human milk; caution should be exercised when administering to a nursing mother. Consult a physician.
Side Effects
Contraindications
- Known hypersensitivity to polymyxin B or any component of the formulation.
- Patients with pre-existing renal impairment, unless the benefits outweigh the risks and close monitoring is possible.
Drug Interactions
Cephalosporins, Penicillins
Antagonistic effects have been reported in some in vitro studies; clinical significance is unclear, but combination therapy generally aims for synergistic effects.
Aminoglycosides (e.g., Gentamicin, Amikacin)
Increased risk of nephrotoxicity and neurotoxicity (ototoxicity). Avoid concomitant use if possible or monitor closely.
Neuromuscular blocking agents (e.g., Vecuronium, Rocuronium)
Polymyxin B can potentiate and prolong neuromuscular blockade, leading to respiratory depression or apnea. Use with extreme caution and monitor respiratory function.
Other nephrotoxic drugs (e.g., NSAIDs, Cyclosporine, Amphotericin B)
Increased risk of renal damage. Monitor renal function frequently.
Storage
Store unopened vials at controlled room temperature (20-25°C / 68-77°F), protected from light. Reconstituted solutions should be stored in a refrigerator (2-8°C / 36-46°F) and used within their specified stability period.
Overdose
Symptoms of overdose include severe nephrotoxicity (acute renal failure), neurotoxicity (dizziness, ataxia, respiratory paralysis, apnea, peripheral neuropathy). Management is primarily supportive, including respiratory support if apnea occurs. Hemodialysis may be considered, but its effectiveness in removing polymyxin B from the body is uncertain.
Pregnancy & Lactation
Pregnancy Category C. Use in pregnancy only if the potential benefit outweighs the potential risk to the fetus. It is not known whether Polymyxin B is excreted in human milk; caution should be exercised when administering to a nursing mother. Consult a physician.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years for unopened vials when stored as recommended. Reconstituted solution stability varies by diluent and concentration, usually 24-72 hours when refrigerated.
Availability
Hospitals, Pharmacies
Approval Status
Approved by major regulatory bodies globally (e.g., FDA)
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials and studies have been conducted on Polymyxin B, evaluating its efficacy, safety, and optimal dosing regimens, particularly in the context of increasing antimicrobial resistance and its use in combination therapies for difficult-to-treat Gram-negative infections.
Lab Monitoring
- Renal function tests (serum creatinine, BUN, urine output, creatinine clearance) daily or every other day
- Electrolytes (especially potassium and magnesium)
- Neurological assessment and monitoring for signs of neurotoxicity
- Liver function tests (baseline and if clinically indicated)
Doctor Notes
- Polymyxin B is a potent, 'last-line' antibiotic reserved for severe, multi-drug resistant Gram-negative infections. Its use requires careful risk-benefit assessment.
- Rigorous monitoring of renal function, electrolytes, and neurological status is paramount during treatment to mitigate and manage potential toxicities.
- Dose adjustments are critical in patients with any degree of renal impairment.
- Consider combination therapy with other antibiotics for synergistic effects and to reduce the emergence of resistance.
Patient Guidelines
- It is crucial to inform your doctor about all current and past medical conditions, especially kidney problems or neuromuscular disorders.
- Report any unusual sensations like numbness, tingling, weakness, or dizziness immediately to your healthcare provider.
- Inform your doctor about all medications, including over-the-counter drugs, herbal supplements, and vitamins.
- Do not stop the medication without consulting your doctor, even if you feel better.
Missed Dose Advice
If a dose is missed, it should be administered as soon as possible. However, if it is almost time for the next scheduled dose, skip the missed dose and continue with the regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Polymyxin B may cause dizziness, visual disturbances, or confusion as side effects. Patients should be advised to avoid driving or operating heavy machinery if they experience these symptoms.
Lifestyle Advice
- Maintain adequate hydration by drinking plenty of fluids unless otherwise advised by your doctor.
- Avoid alcohol consumption during treatment as it may exacerbate side effects.
- Follow all infection control measures as advised by your healthcare provider to prevent further spread of infection.
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