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Continuous infusion of amphotericin B: preliminary experience at Faculdade de Medicina da Fundação ABC
Roberto Palermo Uehara1, Victor Hugo Lara de Sá, Erika Tae Koshimura
1Faculdade de Medicina, Fundação ABC, Hospital Estadual Mário Covas, Santo André, São Paulo, Brazil.
Context And Objective:
Intravenous amphotericin B deoxycholate (AmB-D) infusions, usually given over 4 hours, frequently induce nephrotoxicity and undesirable infusion-related side effects such as rigors and chills. There is evidence in the literature that the use of AmB-D in the form of continuous 24-hour infusion is less toxic than the usual four-hour infusion of this drug. Our objective was to evaluate the efficacy and safety of continuous infusion of AmB-D for the treatment of persistent fever in neutropenic patients with hematological malignancies after chemotherapy.
Design And Setting:
Observational retrospective analysis of our experience with continuous infusion of AmB-D, at Faculdade de Medicina da Fundação ABC and Hospital Estadual Mário Covas in Santo André.
Methods:
From October 2003 to May 2004, 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous infusion of AmB-D.
Results:
The median dose of AmB-D was 0.84 mg/kg/day (0.33 to 2.30 mg/kg/day). Concomitant use of nephrotoxic medications occurred in 92% of the cycles. Nephrotoxicity occurred in 30.76% of the cycles, hypokalemia in 16.67%, hepatotoxicity in 30% and adverse infusion-related events in 23%. All patients survived for at least seven days after starting continuous infusion of AmB-D, and clinical resolution occurred in 76% of the cycles.
Conclusions:
Continuous infusion of AmB-D can be used in our Institution as an alternative to the more toxic four-hour infusion of AmB-D and possibly also as an alternative to the more expensive liposomal formulations of the drug.
Insights
Continuous 24-hour infusion of amphotericin B deoxycholate (AmB-D) offers a safer alternative for treating persistent fever in neutropenic cancer patients. This method demonstrated reduced toxicity compared to standard infusions, improving clinical outcomes.
Area of Science:
- Medical Mycology
- Hematology
- Oncology
Background:
- Standard 4-hour intravenous amphotericin B deoxycholate (AmB-D) infusions are associated with significant nephrotoxicity and infusion-related side effects.
- Continuous 24-hour infusion of AmB-D has been suggested to mitigate these adverse events.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous 24-hour AmB-D infusion for treating persistent fever in neutropenic patients with hematological malignancies.
Main Methods:
- An observational retrospective analysis was conducted.
- 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous AmB-D infusion between October 2003 and May 2004.
Main Results:
- The median AmB-D dose was 0.84 mg/kg/day.
- Nephrotoxicity occurred in 30.76% of cycles, hepatotoxicity in 30%, and infusion-related events in 23%.
- Clinical resolution was achieved in 76% of cycles, with all patients surviving at least seven days post-infusion.
Conclusions:
- Continuous 24-hour infusion of AmB-D is a viable and less toxic alternative to the standard 4-hour infusion.
- It may also serve as a cost-effective alternative to liposomal formulations for treating persistent fever in this patient population.
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