Abstract
Polymyxins B and E (colistin) exert a bactericidal effect on the gram-negative bacterial cell wall, causing permeability changes in the cytoplasmic membrane, leading to cell death. Their use was substantially decreased in clinical practice from the 1970s to 2000s due to their significant nephrotoxicity and neurotoxicity compared to the newly introduced antibiotics. The increasing prevalence of multidrug-resistant gram-negative bacteria infections in this century has led to an upsurge in the use of these “older” drugs. Respiratory paralysis caused by neuromuscular blockage associated with the use of polymyxin B and E was reported mostly in literature published in the 1960s to 1970s with a few reports after 2000. In addition, such a reaction might be enhanced by the presence of other classes of drugs. We report a case of polymyxin B and E–induced apnea in a patient receiving “muscle relaxants.”
Highlights
Polymyxins B (PMB) and E exert a bactericidal effect on the gram-negative bacterial cell wall, causing permeability changes in the cytoplasmic membrane, leading to cell death
Polymyxins B and E are small basic peptides and cationic detergents that exert a bactericidal effect on the gram-negative bacterial cell wall, causing permeability changes in the cytoplasmic membrane, leading to cell death.[1,8]
Their use was substantially decreased in clinical practice from the 1970s to 2000s due to their significant nephrotoxicity and neurotoxicity compared to the “newly” introduced antibiotics.[9]
Summary
Polymyxins B (PMB) and E (colistimethate sodium, colistin [CMS]) exert a bactericidal effect on the gram-negative bacterial cell wall, causing permeability changes in the cytoplasmic membrane, leading to cell death. They were introduced into medical practice in the 1950s but their use was substantially decreased from the 1970s to 2000s due to significant nephrotoxicity and neurotoxicity compared to the newly introduced antibiotics. A surveillance culture 1 month prior to this wound infection did not grow a multidrug-resistant Pseudomonas aeruginosa He was discharged to a nursing home to receive intravenous (IV) meropenem 1 g every 8 hours and oral fluconazole 400 mg daily. 3.7-4.8 mmol/L 1.9-2.4 mg/dL 8.9-10.2 mg/dL 8.9-10.2 mg/dL 3.3-4.6 g/dL 0.8-1.3 mg/dL 3.7-10.3 k/μL 0-0.9 mg/dL
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
