A group of patients with severe
burns were entered into two sequential prospective randomized trials for reduction of
endotoxemia by the use of intravenous
polymyxin B. The first group underwent
polymyxin administration during the first week after
burn injury in a bell-shaped
dosage form constructed to resemble the level of
endotoxemia as previously documented. This group showed a statistically highly significant reduction in
endotoxin levels and a suggestive, but not statistically significant, reduction in
wound infection and mortality in the treated group compared with controls. The second group of patients underwent treatment with perioperative
polymyxin B given in conjunction with an excisional procedure of the
burn wound. In this group,
polymyxin B also accomplished a reduction in
endotoxemia from preoperative to postoperative cases, but there was no significant reduction in clinical complication rate or mortality. In the dosages used,
polymyxin B is nontoxic and promises to be a useful part of the surgeon's armamentarium in dealing with severe complications of gram-negative
sepsis.