Estring Vaginal Ring and Poly-Rx topical

• Generic Name: estradiol topical
• Dosage Forms: n.a.
• Other Brand Names: Estrace Vaginal, Estring, Vagifem, Yuvafem, Imvexxy

Estring vaginal rings contain estradiol. Estradiol (a form of estrogen) is a female sex hormone necessary for many processes in the body. Estring releases estrogen that is absorbed directly through the skin of the vaginal wall.

Estring is used after menopause to treat moderate to severe menopausal changes in and around the vaginal area such as as dryness, burning, and itching of the vaginal area, urgency or irritation with urination, and pain during sexual intercourse).

Estring is an off-white, soft, flexible ring with a center that contains 2 mg of estradiol. The ring releases estradiol into the vagina in a consistent, stable manner for 90 days. It should be removed after 90 days of continuous use. If continued therapy is required, the ring should be replaced.

• Generic Name: polymyxin b
• Dosage Forms: n.a.
• Other Brand Names:

  Poly-Rx

Alternative for treatment of meningeal infections caused by susceptible gram-negative bacteria, including Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Haemophilus influenzae.

Used intrathecally or intraventricularly for treatment of meningitis or other CNS infections. May be effective when used intrathecally alone, but usually used in conjunction with a parenteral anti-infective (e.g., IV or IM polymyxin B, IV meropenem, IV penicillin, IV cephalosporin).

Penetrates poorly into CSF following IM or IV administration; do not use parenteral polymyxin B alone for treatment of meningitis or other CNS infections.

Used for infections that are resistant to or do not respond to regimens of choice.

Respiratory Tract Infections

Alternative for treatment of respiratory tract infections, including nosocomial pneumonia, ventilator-associated pneumonia, or healthcare-associated pneumonia, caused by multidrug-resistant gram-negative bacteria (e.g., Ps. aeruginosa, Acinetobacter baumannii). Used in these infections only when other less toxic anti-infectives are ineffective or contraindicated.

IV polymyxin B has been used alone or in conjunction with IV aztreonam for treatment of nosocomial pneumonia caused by multidrug-resistant Ps. aeruginosa, including those that produce metallo-β-lactamases. Nosocomial infections caused by metallo-β-lactamase-producing Ps. aeruginosa have a high mortality rate, and fatalities may occur despite appropriate anti-infective therapy. Optimal regimens for treatment of these infections not identified to date.

Administered by oral inhalation via nebulization for treatment of respiratory tract infections caused by susceptible gram-negative bacteria (e.g., Ps. aeruginosa, A. baumannii). Generally used in conjunction with a parenteral anti-infective (e.g., IV polymyxin B); has been effective when given by oral inhalation alone in some patients with infections caused by susceptible gram-negative bacteria.

Although safety and efficacy not established and additional study needed, ATS, IDSA, and other clinicians suggest that adjunctive use of aerosolized polymyxin B can be considered for treatment of serious respiratory tract infections (e.g., ventilator-associated pneumonia) caused by multidrug-resistant gram-negative bacteria that have not responded to treatment with parenteral anti-infectives alone.

Septicemia

Treatment of septicemia or bacteremia caused by susceptible Ps. aeruginosa, Enterobacter aerogenes, or K. pneumoniae. Also has been used for treatment of bloodstream infections caused by multidrug-resistant A. baumannii.

Generally used only when other less toxic anti-infectives are ineffective or contraindicated.

May be a drug of choice for treatment of septicemia or bacteremia caused by Ps. aeruginosa. Has been used alone or in conjunction with other anti-infectives (e.g., aztreonam) for infections caused by multidrug-resistant Ps. aeruginosa, including those that produce metallo-β-lactamases. Nosocomial blood stream infections caused by metallo-β-lactamase-producing Ps. aeruginosa have a high mortality rate, and fatalities may occur despite appropriate anti-infective therapy. Optimal regimens for treatment of these infections not identified to date.

Urinary Tract Infections (UTIs)

Treatment of serious UTIs caused by susceptible Ps. aeruginosa or E. coli.

Generally used only when other less toxic anti-infectives are ineffective or contraindicated.

Bacteriuria and Bacteremia Associated with Indwelling Catheters

Fixed-combination solution for irrigation containing polymyxin B and neomycin used in abacteriuric patients for short-term (≤10 days) irrigation or rinse of the urinary bladder to help prevent bacteriuria and gram-negative rod septicemia associated with use of indwelling catheters.

Some clinicians state that irrigation or rinse of the urinary bladder with anti-infective solutions is unlikely to be of benefit while the catheter is in place and such a strategy is not recommended.

Use fixed-combination solution for irrigation only for irrigation of the bladder; do not use for irrigation of other areas.