2012 Volume 3 Issue 2 Pages 109-116
Polymyxin B immobilized fiber cartridge (PMX) has been used clinically in some countries in Europe and Asia outside Japan with good safety results. Sustained septic shock after surgery due to abdominal infection is a good indication for PMX, and a similar clinical improvement has been reported in these countries as in Japan. A biomarker to direct PMX treatment is urgently needed not only to give a rational for PMX use, but also for a rapid diagnosis of endotoxemia. A FDA approved blood endotoxin measurement method (EAA) has been used in some countries to diagnose endotoxemia and select an appropriate patient who are most likely to benefit from PMX treatment. Two multicenter randomized controlled studies, EUPHRATES trial in North America and ABDO-MIX in France are currently recruiting patients. These two studies are being expected to give a definitive answer for the effectiveness of PMX in reducing mortality and improving clinical parameters. While the complete mechanism of action of PMX is still not fully understood, regulation of inflammatory mediators as a result of endotoxin removal and the immunomodulatory effect associated with the removal of immune cells, such as monocytes and neutrophils with PMX have been proposed. To proceed from a phenomenological observation to an essential explanation for the complete mechanism of action of PMX treatment, further study is still needed to clarify the role of PMX and the other associated biochemical alterations in the clinical settings.
