Polymyxin B-induced acute kidney injury in a burn patient: a case report and pharmaceutical care
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By
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Shanshan Ding
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May 7, 2026
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Clinical Scorecard: Acute Kidney Injury Associated with Polymyxin B in a Burn Patient: A Case Study and Review of Pharmaceutical Management
At a Glance
| Category | Detail |
|---|
| Condition | Acute Kidney Injury (AKI) associated with Polymyxin B |
| Key Mechanisms | Polymyxin B enhances bacterial cell membrane permeability, neutralizes endotoxin, and facilitates bacterial lysis. |
| Target Population | Patients with burns and sepsis, particularly those with multidrug-resistant Gram-negative infections. |
| Care Setting | Intensive Care Unit (ICU) and acute care settings. |
Key Highlights
- Polymyxin B is associated with a significant risk of nephrotoxicity, especially in burn patients.
- Prompt renal function assessment and dosage modification are crucial within 3 days of therapy initiation.
- Therapeutic drug monitoring is recommended to ensure patient safety.
- The Naranjo score indicated a probable link between polymyxin B and AKI.
- Renal function improved after dose reduction of polymyxin B.
Guideline-Based Recommendations
Diagnosis
- Assess renal function using KDIGO criteria for AKI.
Management
- Modify polymyxin B dosage based on renal biomarkers and infection response.
Monitoring & Follow-up
- Daily assessment of renal function (creatinine, BUN) and urine output every 6 hours.
Risks
- Increased risk of AKI in patients with burns receiving polymyxin B.
Patient & Prescribing Data
44-year-old male with 66% TBSA burns and sepsis.
Initial dose of polymyxin B was 50 mg IV q12h, increased to 100 mg q12h, then reduced back to 50 mg q12h due to rising creatinine levels.
Clinical Best Practices
- Implement vigilant monitoring for renal toxicity in patients receiving polymyxin B.
- Avoid concurrent nephrotoxic medications during polymyxin B therapy.
- Ensure timely intervention based on renal function assessments.
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