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Related Concept Videos

Antifungal Agents01:15

Antifungal Agents

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Amphotericin B is a broad-spectrum antifungal agent that exploits structural differences between fungal and mammalian cell membranes. Its amphipathic structure—featuring a hydrophobic polyene-lactone ring and a hydrophilic region containing mycosamine and carboxylic acid groups—enables selective binding to ergosterol, a sterol predominantly found in fungal plasma membranes. This selective interaction underlies the drug’s antifungal activity, although weak binding to...
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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

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In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

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In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
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Amphotericin B deoxycholate versus liposomal amphotericin B: effects on kidney function.

Juan Pablo Botero Aguirre1, Alejandra Maria Restrepo Hamid

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Liposomal amphotericin B is safer for kidney function than conventional amphotericin B, with fewer infusion-related reactions. This review of randomized controlled trials confirms liposomal amphotericin B

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections are increasing globally.
  • Conventional amphotericin B (sodium deoxycholate) is standard treatment but causes acute kidney injury (AKI).
  • Newer amphotericin B formulations aim to reduce adverse drug reactions.

Purpose of the Study:

  • To compare the effects of conventional amphotericin B deoxycholate versus liposomal amphotericin B on kidney function.
  • To assess the safety and efficacy of different amphotericin B formulations.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched Cochrane Kidney and Transplant's Specialised Register.
  • Included 12 RCTs comparing amphotericin B deoxycholate with liposomal amphotericin B.

Main Results:

  • Liposomal amphotericin B showed significantly lower serum creatinine increases (RR 0.49) compared to conventional amphotericin B.
  • Fewer infusion-related reactions (fever, chills, nausea, vomiting) were observed with liposomal amphotericin B.
  • Included studies had low to unclear risk of bias in most domains, with robust review results.

Conclusions:

  • Liposomal amphotericin B is less nephrotoxic than conventional amphotericin B regarding serum creatinine levels.
  • Liposomal amphotericin B is associated with a reduced incidence of infusion-related reactions.
  • Evidence suggests liposomal amphotericin B offers an improved safety profile for treating invasive fungal infections.