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ORAL REHYDRATION SOLUTION TO PREVENT NEPHROTOXICITY OF AMPHOTERICIN B

Treatment with amphotericin B deoxycholate (AB) is associated with dose-related nephrotoxicity. We conducted an open and randomized trial to evaluate the efficacy of an oral rehydration solution (ORS) to prevent nephrotoxicity of AB, compared with an intravenous saline solution (SS). Adult patients with mucosal leishmaniasis in whom AB was indicated received either three liters or ORS or one liter of SS. Renal function tests were performed at baseline and during treatment. Forty-eight patients were included (ORS = 25, SS = 23). No difference was observed in serum creatinine, creatinine clearance, serum urea, and serum sodium values during treatment, but serum potassium values were lower in the SS group than in the ORS group (P < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, P = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.

Received July 28, 2006. Accepted for publication August 7, 2006.

Acknowledgments: The authors thank Dennis Grasela, Diego Gonzalez, Jaime Espinoza, Juan Miyahira, and Julieta Tupayachi for their support in conducting the study, and Pedro Legua for reviewing the manuscript.

Financial support: This study was supported by core funds of Instituto de Medicina Tropical Alexander von Humboldt. Amphotericin B was provided by Bristol Myers Squibb, Peru. The American Committee on Clinical Tropical Medicine and Travelers’ Health (ACCTMTH) assisted with publication expenses.

^* Address correspondence to Juan Echevarria, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima. AP 4314, Lima 100, Peru. E-mail: chito{at}upch.edu.pe

Authors’ addresses: Juan Echevarria, MD, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima. AP 4314, Lima 100, Peru, Telephone: 51-1-4823910, Fax: 51-1-4823404, E-mail: chito{at}upch.edu.pe. Carlos Seas, MD, In-stituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima. AP 4314, Lima 100, Peru, Telephone: 51-1-4823910, Fax: 51-1-4823404, E-mail: cseas{at}upch.edu.pe. Maria Cruz, MD, Departamento de Medicina del Hospital Nacional Sur Este - Essalud Cuzco, Perú. Av Juan Anselmo Alvares S/N, Wanchaq. Cuzco-Perú, Telephone/Fax: 51-84-234724, E-mail: mcruzvene{at}yahoo.com.arg. Elaine Chávez, MD, Centro Médico Asistencial Casa Hogar del Campesino "Hermana Josefina Serrano", ABC, PRODEIN, San Andrés 321, Apartado 413, Cuzco- Perú, Telephone/Fax: 51-84-232331, E-mail: casahogar{at}prodein.org. Miguel Campos, MD, PhD, Departamento de Fisica, Informática y Matem-aticas. Universidad Peruana Cayetano Heredia, Lima, AP 4314, Lima 100, Perú, Telephone: 51-1-4814249, Fax: 51-1-4823404, E-mail: viper{at}upch.edu.pe. Javier Cieza, MD, Servicio de Nefrología, De-partamento de Medicina, Hospital Nacional Cayetano Heredia, Lima, Perú. Av. Honorio Delgado S/N, San Martín de Porras, Lima 34, Perú, Telephone: 51-1-4818215, Fax: 51-1-4820828, E-mail: ciezaja{at}hotmail.com. Eduardo Gotuzzo, MD, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima. AP 4314, Lima 100, Peru, Telephone: 51-1-4823910 Fax: 51-1-4823404, E-mail: egh{at}upch.edu.pe. Alejandro Llanos, MD, PhD, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima. AP 4314, Lima 100, Peru, Telephone: 51-1-4827739, Fax: 51-1-4823404, E-mail: allanos{at}upch.edu.pe