Polymyxin Vancomycin

The answer is c. (Hardman, pp 1143-1144.) Bacitracin, cycloserine, cephalothin, and vancomycin inhibit cell-wall synthesis and produce bacteria that are susceptible to environmental conditions. Polymyxins disrupt the structural integrity of the cytoplasmic membranes by acting as cationic detergents. On contact with the drug, the permeability of the membrane changes. Polymyxin is often applied in a mixture with bacitracin and/or neomycin for synergistic effects. 

Heparin and its salts are incompatible with many drugs including alteplase, amikacin sulfate, amiodarone hydrochloride, ampicillin sodium, aprotinin, benzylpenicillin potassium or sodium, cephalothin sodium, ciprofloxacin lactate, cytarabine, dacarbazine, daunorubicin hydrochloride, diazepam, dobutamine hydrochloride, doxorubicin hydrochloride, droperidol, erythromycin lactobionate, gentamicin sulfate, haloperidol lactate, hyaluronidase, hydrocortisone sodium succinate, kanamycin sulfate, methicillin sodium, netilmicin sulfate, some opioid analgesics, oxytetracycline hydrochloride, some phenothiazines, polymyxin B sulfate, streptomycin sulfate, tetracycline hydrochloride, tobramycin sulfate, vancomycin hydrochloride, vinblastine sulfate, cisatracurium besylate, labetalol hydrochloride, nicardipine hydrochloride, cefmetazole, sodium ions, and fat emulsion.110 112... 

A 65-year-old man undergoing elective sternal debridement and rewiring was given a prophylactic infusion of vancomycin 1 g preoperatively. Anesthesia was induced with thiopental, suxamethonium, and fentanyl, and maintained with fentanyl, vecuronium, and isoflurane. A few minutes after wound irrigation with bacitracin (about 25U/ml), his blood pressure fell precipitously, necessitating intravenous fluids and adrenaline. His face and arms were flushed. Afterwards, he reported having had a rash several years before after the use of an over-the-counter ointment composed of polymyxin B, bacitracin, and neomycin. 

Polypeptides Bacitracin, Colistimethate sodium, Colistin, Polymyxin B, Tekoplanin, Vancomycin... 

A study in 10 patients with small cell bronchogenic carcinoma taking methotrexate found that when they were also given a range of oral anti-in-feetives (paromomycin, vancomycin, polymyxin B, nystatin) the urinary recovery of methotrexate was reduced by over one-third (from 69% to 44%). The paromomycin was believed to have been responsible. In another study the concurrent use of neomycin 500 mg four times a day for 3 days reduced the methotrexate AUC and the 72-hour cumulative excretion by 50%. In contrast, the same report suggests that kanamycin can increase the absorption of methotrexate, but no details are given. 

The polymyxin program did not proceed into the clinic but translatability was still addressed using samples from patients treated with a variety of standard of care antibiotics (piperacilhn/tazobactam, vancomycin, penicillin V, tobramycin, gentamicin, ampicillin, cefuroxime, clindomycin, clarithromycin, cefepime, daptomycin IV, bumetanide, vibramycin, and cyclophosphamide) compared to samples from healthy volunteers. This sample set was analyzed for sCr, BUN, urinary total protein, and urinary microalbumin as well as the emerging biomarkers urinary KIM-1, urinary NGAL, and urinary NAG. Much like the large animal studies with polymyxin B, the response for the antibiotic-treated cohort produced increases in all urinary- and serum-based... 

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