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Normal Saline contains chloride ions that interact with the positively charged polymyxin molecule, leading to drug degradation and reduced antibacterial activity during prolonged infusion

Prez-Albaladejo, E

13 In 1993, The Journal of Clinical Apheresis published a paper detailing the use of TPE as either a first- or second-line therapy to be used with other modalities on disorders such as Raynauds disease, systemic lupus erythematosus, coagulation factor inhibitors, familial hypercholesterolemia, acute Guillain-Barr syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, cryoglobulinemia, Goodpastures syndrome, and thrombotic thrombocytopenic purpura

As a result, vaccine development was deemed to be a low priority, and it was thought that due to concurrent circulation, a quadrivalent vaccine would be needed

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