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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Pharmacology of Infectious Diseases
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1466888

Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study

Provisionally accepted
Yalin Dong Yalin Dong 1*Yijing Zhang Yijing Zhang 1Chuhui Wang Chuhui Wang 1Jiaojiao Chen Jiaojiao Chen 1Chuqi Bai Chuqi Bai 1Dan Sun Dan Sun 2Yulan Qiu Yulan Qiu 1Mengmeng Teng Mengmeng Teng 1
  • 1 Department of Pharmacy, First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
  • 2 Xi’an Hospital of Traditional Chinese Medicine, Xi’an, Shaanxi Province, China

The final, formatted version of the article will be published soon.

    Background: Polymyxin B sulfate (PBS) and colistin sulfate (CS) are the last-line treatments for infections caused by multidrug-resistant Gram-negative bacteria, but their efficacy and safety have not been validated. The aims of the current study were to (1) determine their efficacy and safety among critically ill patients and the influencing factors, and (2) determine the relationships of drug exposure with efficacy and safety, to provide evidence for the precision dosing.Method: This retrospective study included 100 critically ill patients treated with PBS and 80 treated with CS. The efficacy outcomes were clinical efficacy and 30-day mortality, while the safety indicator was acute kidney injury (AKI) incidence.Result: There was no significant difference between the two drugs in clinical efficacy, 30-day mortality, or overall AKI incidence, but the incidence of stage 3 AKI was significantly higher in the PBS cohort than the CS cohort. Therapeutic drug monitoring (TDM) and trough concentration (Cmin) were significantly associated with clinical efficacy and AKI in both cohorts. Classification and regression tree analysis revealed that Cmin values of ≥0.91 mg/L for PBS and Cmin ≥0.53 mg/L for CS were associated with higher clinical efficacy.There is basically no significant difference in the efficacy and safety of PBS and CS.TDM can significantly improve the clinical efficacy of both drugs and reduce the incidence of AKI.TDM is therefore recommended to improve the clinical efficacy while reducing the adverse reactions.

    Keywords: Polymyxin B, Colistin sulfate, critically ill patients, multidrug-resistant Gramnegative bacteria, Therapeutic drug monitoring

    Received: 18 Jul 2024; Accepted: 09 Dec 2024.

    Copyright: © 2024 Dong, Zhang, Wang, Chen, Bai, Sun, Qiu and Teng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yalin Dong, Department of Pharmacy, First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.