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Implementation of clinical practice policy on the continuous intravenous administration of amphotericin B

Pasri Maharom1, Visanu Thamlikitkul

  • 1Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|August 28, 2007
PubMed
Abstract

Insights

Continuous infusion of amphotericin B reduces infusion reactions and nephrotoxicity in patients with systemic fungal infections. This method offers a safer alternative to conventional dosing, improving patient outcomes.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Pharmacy

Background:

  • Systemic fungal infections are increasing, with amphotericin B deoxycholate as a primary treatment.
  • Conventional amphotericin B administration is linked to infusion reactions and nephrotoxicity.
  • Continuous infusion of amphotericin B has shown potential in mitigating these adverse effects.

Purpose of the Study:

  • To implement a clinical practice policy for continuous intravenous amphotericin B administration.
  • To evaluate the safety and efficacy of continuous versus conventional amphotericin B infusion in hospitalized patients.

Main Methods:

  • A one-page evidence-based clinical practice policy was developed and disseminated.
  • Patient data receiving amphotericin B between March 2004 and March 2006 were collected and analyzed.
  • Descriptive statistics, univariate, and multivariate analyses were employed.

Main Results:

  • Of 166 treatment courses, 61.4% used continuous infusion (CI) and 38.6% used conventional infusion (RI).
  • The CI group showed significantly lower incidence of chills (6.9% vs. 26.6%, p=0.001) and a trend towards less nephrotoxicity (27.5% vs. 39.1%, p=0.164).
  • While overall mortality was higher in the CI group, deaths were largely unrelated to fungal infections or amphotericin B.

Conclusions:

  • Continuous infusion amphotericin B is associated with reduced infusion-related reactions.
  • Continuous infusion demonstrates a trend towards decreased nephrotoxicity compared to conventional infusion.
  • Implementation of continuous infusion amphotericin B policy is supported by evidence of improved tolerability.

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