A Study on Polymyxin B Induced Nephrotoxicity: A Systematic Review

Polymyxins are a group of cationic polypeptide antibiotics effective against several Gram-negative bacteria. The emerging experience with Polymyxin B, indicated that up to half of the patients receiving this drug presented nephrotoxicity. More recent studies using standardized criteria for AKI, such as Kidney Disease: Improving Global Outcomes (KDIGO), Acute Kidney Injury Network (AKIN) and Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE), have been published, among which, a recent metaanalysis showed that the occurrence of AKI remained undesirably high with mean rates of 31.3%, 32.6% and 39.4%, respectively. Polymyxins act primarily upon the external and cytoplasmic membranes, with similar action to that of simple cationic detergents. The mechanism of action is thought to be based on surfactant activity, which disrupts the bacterial outer and cytoplasmic membranes. Polymyxin B is used at the dose of 1.5 to 2.5 mg/kg/day (1.0 mg of polymyxin B = 10,000 IU) in patients with normal renal function. The development of renal injury, is the major limiting factor for the use of this class of antibiotics. Identifying ways to minimize nephrotoxicity associated with polymyxin B use is critical to advance clinical practice.