Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infections

J Antimicrob Chemother. 2004 Aug;54(2):566-9. doi: 10.1093/jac/dkh369. Epub 2004 Jul 21.


Background: The treatment of infections caused by multidrug-resistant (MDR) Gram-negative organisms poses a therapeutic challenge. The use of polymyxin B has been resurrected specifically for this purpose.

Patients and methods: We retrospectively reviewed the clinical and microbiological efficacy, and safety profile of polymyxin B in the treatment of MDR Gram-negative bacterial infections of the respiratory tract. Twenty-five critically ill patients received a total of 29 courses of polymyxin B administered in combination with another antimicrobial agent.

Results: Patients were treated with intravenous, and/or aerosolized polymyxin B. Mean duration of polymyxin B therapy was 19 days (range 2-57 days). End of treatment mortality was 21%, and overall mortality at discharge was 48%. Nephrotoxicity was observed in three patients (10%) and did not result in discontinuation of therapy.

Conclusions: Polymyxin B in combination with other antimicrobials can be considered a reasonable and safe treatment option for MDR Gram-negative respiratory tract infections in the setting of limited therapeutic options.

MeSH terms

  • Acinetobacter baumannii / drug effects
  • Administration, Inhalation
  • Adult
  • Aged
  • Aged, 80 and over
  • Alcaligenes / drug effects
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Critical Illness
  • Drug Resistance, Multiple, Bacterial*
  • Drug Therapy, Combination
  • Female
  • Germany / epidemiology
  • Gram-Negative Bacterial Infections / drug therapy*
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / mortality
  • Humans
  • Injections, Intravenous
  • Kidney Diseases / chemically induced
  • Kidney Diseases / epidemiology
  • Male
  • Middle Aged
  • Polymyxin B / administration & dosage
  • Polymyxin B / adverse effects
  • Polymyxin B / therapeutic use*
  • Pseudomonas aeruginosa / drug effects
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / mortality
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Polymyxin B