Publication: Effectiveness and safety of polymyxin B for the treatment of infections caused by extensively drug-resistant gram-negative bacteria in Thailand
Issued Date
2018-01-01
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ISSN
11786973
Other identifier(s)
2-s2.0-85057768759
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Mahidol University
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SCOPUS
Bibliographic Citation
Infection and Drug Resistance. Vol.11, (2018), 1219-1224
Suggested Citation
Thundon Ngamprasertchai, Adhiratha Boonyasiri, Lantharita Charoenpong, Sireethorn Nimitvilai, Narisorn Lorchirachoonkul, Luksame Wattanamongkonsil, Visanu Thamlikitkul Effectiveness and safety of polymyxin B for the treatment of infections caused by extensively drug-resistant gram-negative bacteria in Thailand. Infection and Drug Resistance. Vol.11, (2018), 1219-1224. doi:10.2147/IDR.S169939 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/47207
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Title
Effectiveness and safety of polymyxin B for the treatment of infections caused by extensively drug-resistant gram-negative bacteria in Thailand
Abstract
© 2018 Ngamprasertchai et al. 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.