Emergence of polymyxin B as a viable treatment option in comparision to newer antimicrobials in Intensive Care Units: A study in North India

  • Meher Rizvi
  • Naushaba Siddiqui SENIOR RESIDENT
  • Fatima Khan
  • Asfia Sultan
  • Parvez Anwar Khan
  • Indu Shukla
  • Haris M. Khan
Keywords: Resistance, ICU, Polymyxin B, Tigecycline, Floroquinolones, Carbapenem


Background: Multidrug resistance (MDR) among gram-negative bacilli has increased substantially limiting the choice of antimicrobials. This study was conducted with the objective to determine the efficacy of tigecycline , polymyxin B, newer floroquinolones and newer carbapenems against MDR gram negative isolates.Methods: 90 clinical samples were obtained  from ICU patients. On  basis of  antibiotic susceptibility to first line antibiotics isolates were divided into 3 groups- a)sensitive to all the first line drugs, b) sensitive only to injectables and c) resistant to all antibiotics except imipenem.These groups were then  tested against enoxacin(10 μg), gemifloxacin (5μg), moxifloxacin (5μg), prulifloxacin (5μg), ertapenem (10μg), faropenem (5μg), tigecycline (15μg) and polymyxin B (300 units). Isolates were screened for  ESBL, AmpC, CRE and   MBL.Results: All  the isolates in group 1 were uniformly sensitive to all the new antimicrobials tested. In group 2 susceptibility  profile was as follows -100%  sensitive to  polymyxin B, 16.6% to tigecycline, 10% to enoxacin,  3.3% to gemifloxacin, moxifloxacin, prulifloxacin, ertapenem and faropenem. In group 3, 81.5% of the isolates were sensitive to polymyxin B, 13.2% to tigecycline,  3.3% each to gemifloxacin and ertapenem.. Isolates of the  three groups were uniformly sensitive to imipenem(100%). 2(6.67%) of the isolates were ESBL producers  and  30 (33.3%) were AmpC producers. No CRE and MBL were detected.Conclusion: Polymyxin B emerged as  most effective antimicrobial in group 2 and group 3 with 100% and 81.5%  sensitivity respectively. Use of polymyxin B will  prevent  injudicious use of imipenem and will decrease escalation of MBLs in our facility.

Author Biography

Naushaba Siddiqui, SENIOR RESIDENT


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Original Article