Infection and Drug Resistance (Aug 2018)

Effectiveness and safety of polymyxin B for the treatment of infections caused by extensively drug-resistant Gram-negative bacteria in Thailand

  • Ngamprasertchai T,
  • Boonyasiri A,
  • Charoenpong L,
  • Nimitvilai S,
  • Lorchirachoonkul N,
  • Wattanamongkonsil L,
  • Thamlikitkul V

Journal volume & issue
Vol. Volume 11
pp. 1219 – 1224

Abstract

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Thundon Ngamprasertchai,1 Adhiratha Boonyasiri,2 Lantharita Charoenpong,3 Sireethorn Nimitvilai,4 Narisorn Lorchirachoonkul,5 Luksame Wattanamongkonsil,2 Visanu Thamlikitkul6 1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; 2Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 3Division of Medicine, Chaophraya Yommarat Hospital, Suphanburi, Thailand; 4Division of Medicine, Nakhornpathom Hospital, Nakhornpathom, Thailand; 5Division of Medicine, Ratchaburi Hospital, Ratchaburi, Thailand; 6Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: Colistimethate sodium (colistin) has been used in the treatment of infections caused by extensively drug-resistant (XDR) Gram-negative bacteria in Thailand over the past decade, with a mortality rate of 50% and a nephrotoxicity rate of 40%. Polymyxin B has not been available in Thailand. We conducted a Phase II clinical study to determine the effectiveness and safety of polymyxin B, compared with colistin, for the treatment of XDR Gram-negative bacterial infections in Thai patients.Methods: A total of 73 adult patients hospitalized at four participating tertiary care hospitals from January 2015 to December 2015 who had infections caused by XDR Gram-negative bacteria and had to receive colistin were enrolled in the study. Polymyxin B (100 mg/day) was administered intravenously every 12 hours for 7–14 days.Results: Most of the patients were older males with comorbidities who had received antibiotics, particularly carbapenems, prior to receiving polymyxin B. More than half of the patients had pneumonia, and 51.5% of the infections were caused by XDR Acinetobacter baumannii, which was susceptible to colistin. Good clinical responses at the end of treatment were observed in 78.1% of cases, the overall 28-day mortality rate from all causes was 28.7%, the microbiological clearance of the targeted bacteria after therapy was 56.2% and nephrotoxicity occurred in 24.7% of cases. Neurotoxicity relating to reversible numbness was observed in two cases.Conclusion: Polymyxin B seems to be effective and safe for the treatment of XDR Gram-negative bacterial infections. Polymyxin B should be considered as an alternative to colistin for treatment of infections caused by XDR Gram-negative bacteria in Thai adult patients, especially those at risk of nephrotoxicity. Keywords: mortality, acute kidney injury, Acinetobacter baumannii

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