Optimization of polymyxin B regimens for the treatment of carbapenem-resistant organism nosocomial pneumonia: a real-world prospective study
Authors' conclusion
For CRO pneumonia, daily dose of 75 and 100 mg Q12 h was recommended for clinical efficacy.
Study context
- Population
- Critically ill patients treated with polymyxin B for carbapenem-resistant organism (CRO) nosocomial pneumonia295 plasma concentrations
- Participants
- 105 patients
- Outcome
- Relationship between polymyxin B exposure and efficacy (predictors and PK/PD indices of efficacy)
Methodological detailsreal-world, population PK analysis, Monte Carlo simulation
- Real-world
- Population PK analysis
- Monte Carlo simulation
Main finding
As reported in the abstract
Independent factors for polymyxin B efficacy (logistic regression)
Adjusted odds ratio (95% CI)P value
AUCss,24 h/MIC
0.97(0.95–0.99)
P = 0.009Daily dose
0.98(0.97–0.99)
P = 0.028Combination of inhaled polymyxin B
0.32(0.11–0.94)
P = 0.039- AUCss,24 h/MIC the most predictive PK/PD index (ROC); optimal cutoff in patients on combination therapy with another antimicrobial
- 66.9
Observational data: associations, not effects.
Further findings
Model-based simulation: PTA of the clinical target
- Maintenance daily dose 75 mg Q12 h achieves ≥ 90% PTA at MIC ≤ 0.5 mg/L
- Maintenance daily dose 100 mg Q12 h achieves ≥ 90% PTA at MIC 1 mg/L
Original publication
Optimization of polymyxin B regimens for the treatment of carbapenem-resistant organism nosocomial pneumonia: a real-world prospective study. Crit Care. Published 28 April 2023. doi:10.
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