Background: Polymyxins, including colistin and polymyxin B, are considered salvage therapy to treat infections caused by multidrug-resistant gram-negative bacteria. Despite their importance, the clinical use of polymyxins is often constrained by their narrow therapeutic index, especially due to nephrotoxicity and neurotoxicity. Paresthesia associated with polymyxin B is often underreported, not fully understood, and only a few cases highlight this. Case presentation: We present a case of transient paresthesia occurring shortly after the administration of a loading dose of polymyxin B in a critically ill 33-year-old South Asian woman with intra-abdominal sepsis. Interestingly, the symptoms resolved spontaneously despite the continuation of the maintenance regimen. Conclusion: This case highlights the under-recognized neurotoxic potential of polymyxin B, particularly during loading doses, and underscores the importance of vigilance and individualized clinical judgment when balancing antimicrobial efficacy with tolerability.
Joshi et al. (Mon,) studied this question.