Polymyxin Acute Kidney Injury: Dosing and Other Strategies to Reduce Toxicity.

Article Details

Citation

Nation RL, Rigatto MHP, Falci DR, Zavascki AP

Polymyxin Acute Kidney Injury: Dosing and Other Strategies to Reduce Toxicity.

Antibiotics (Basel). 2019 Mar 14;8(1). pii: antibiotics8010024. doi: 10.3390/antibiotics8010024.

PubMed ID
30875778 [ View in PubMed
]
Abstract

Polymyxins are valuable antimicrobials for the management of multidrug-resistant Gram-negative bacteria; however, nephrotoxicity associated with these drugs is a very common side effect that occurs during treatment. This article briefly reviews nephrotoxic mechanisms and risk factors for polymyxin-associated acute kidney injury (AKI) and discusses dosing strategies that may mitigate kidney damage without compromising antimicrobial activity. Polymyxins have a very narrow therapeutic window and patients requiring treatment with these drugs are frequently severely ill and have multiple comorbidities, which increases the risk of AKI. Notably, there is a significant overlap between therapeutic and toxic plasma polymyxin concentrations that substantially complicates dose selection. Recent dosing protocols for both colistin and polymyxin B have been developed and may help fine tune dose adjustment of these antibiotics. Minimizing exposure to modifiable risk factors, such as other nephrotoxic agents, is strongly recommended. The dose should be carefully selected, particularly in high-risk patients. The administration of oxidative stress-reducing drugs is a promising strategy to ameliorate polymyxin-associated AKI, but still requires support from clinical studies.

DrugBank Data that Cites this Article

Drugs
Drug Interactions
DrugsInteraction
Polymyxin B
Cyclosporine
The risk or severity of adverse effects can be increased when Cyclosporine is combined with Polymyxin B.
Polymyxin B
Icosapent
The risk or severity of adverse effects can be increased when Icosapent is combined with Polymyxin B.
Polymyxin B
Cefotiam
The risk or severity of adverse effects can be increased when Cefotiam is combined with Polymyxin B.
Polymyxin B
Mesalazine
The risk or severity of adverse effects can be increased when Mesalazine is combined with Polymyxin B.
Polymyxin B
Cefmenoxime
The risk or severity of adverse effects can be increased when Cefmenoxime is combined with Polymyxin B.