Treatment of multi drug resistant gram negative bacilli with inhaled polymyxin-b

Abstract

Introduction: A major challenge has arisen regarding the treatment of infections caused by Gram-negative bacilli, particularly those with high level intrinsic resistance to many antibiotic classes and extreme ability to acquire resistance. Aim: The present study was conducted to assess the safety and efficacy of aerosolized polymyxin-B in comparison to intravenous polymyxin-B therapy for treatment of MDR GNB. Materials and methods: Study was performed over a period of 18 months. A Comparative two group randomized clinical study with 50 patients with 25 patients in Group A and 25 patients in Group-B is undertaken to study the outcome of therapy, fever response to therapy and side effects. Results: Mean duration of ICU stay was 28.68±9.15 days in Group-A while it was 31.64±9.16 days in Group-B. This was not statistically significant with p-value 0.258786. Pseudomonas aeruginosa is the most common organism isolated .In this study improvement, cure and failure rates were 44%, 44% and 12% respectively in Group-A(inhaled polymyxin b). while improvement,cure and failure rates were 40%,20% and 40% in Group-B(iv Polymyxin B) which was statistically significant. fever response to study was better in Group-A (inhaled polymyxin B) which was statistically significant. Adverse events to polymyxin B Inhalation (bronchospasm) occurred in 16% of the patients in group-A , Nephotoxicity in 28% of patients in group –B.but did not lead to suspension of treatment. Conclusion: Inhaled polymyxin-B was useful in treatment of nosocomial pneumonia caused by MDR-GNB in mechanically ventilated patients. As the drug is given by inhalational route systemic side effects can be minimized.