1921
Volume 75, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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 ( < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.

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2006-12-01
2017-09-24
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References

  1. Gallis H, Drew R, Pickard W, 1990. Amphotericin B: 30 years of clinical experience. Rev Infect Dis 12 : 308–329.
  2. Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE, Infectious Diseases Society of America, 2004. Guidelines for the treatment of candidiasis. Clin Infect Dis 38 : 161–189.
  3. Patterson T, 1998. Approaches to therapy for invasive mycoses—the role of amphotericin B. Clin Infect Dis 26 : 339–340.
  4. Olliaro P, Guerin P, Gerstl S, Haakjold A, Rottingen J, Sundar S, 2005. Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India. Lancet Infect Dis 5 : 763–774.
  5. Murray H, Berman J, Davies C, Saravia N, 2005. Advances in leishmaniasis. Lancet 366 : 1561–1577.
  6. Deray G, 2002. Amphotericin B nephrotoxicity. J Antimicrob Chemother 49 : 37–41.
  7. Sawaya B, Weihprecht H, Campell W, 1991. Direct vasoconstriction as a possible cause for amphotericin B-induced nephrotoxicity in rats. J Clin Invest 87 : 2097–2107.
  8. Stein R, Alexander J, 1989. Sodium protects against neprhotoxicity in patients receiving amphtotericin B. Am J Med Sci 295 : 299–304.
  9. Llanos A, Cieza J, Bernardo J, 1991. Effect of salt supplementation on amphotericin B nephrotoxicity. Kidney Int 40 : 302–308.
  10. Ostrosky-Zeichner L, Marr K, Rex J, Cohen S, 2003. Amphotericin B: Time for a new “gold standard”. Clin Infect Dis 37 : 415–425.
  11. Garnacho-Montero J, Ortiz-Leyba C, Garmendia J, Jimenez F, 1998. Life-threatening adverse event after amphotericin B lipid complex treatment in a patient treated previously with amphotericin B deoxycholate. Clin Infect Dis 26 : 1016.
  12. Denning D, 2003. Echinocandin antifungal drugs. Lancet 362 : 1142–1151.
  13. Deresinski S, Stevens D, 2003. Caspofungin. Clin Infect Dis 36 : 1445–1457.
  14. Kale P, Johnson L, 2005. Second-generation azole antifingal agents. Drug Today 41 : 91–105.
  15. Harbath S, Pestotnik S, Lloyd J, Butke J, Samore M, 2001. The epidemiology of nephrotoxicity associated with conventional amphotericin B therapy. Am J Med 111 : 528–534.
  16. Pathak A, Pien F, Carvalho L, 1998. Amphotericin B use in a community hospital, with special emphasis on side effects. Clin Infect Dis 26 : 334–338.
  17. Luber A, Maa L, Lam M, Giglielmo B, 1999. Risk factors for amphotericin B-induced nephrotoxicity. J Antimicrob Chemother 43 : 267–271.
  18. Costa S, Nucci M, 2001. Can we decrease amphotericin nephrotoxicity? Curr Opin Crit Care 7 : 379–383.
  19. Fanos V, Cataldi L, 2000. Amphotericin B-induced nephrotoxicity: a review. J Chemother 12 : 463–470.
  20. Harbath S, Burke J, Lloyd J, Evans R, Pestotnik S, Samore M, 2002. Clinical and economical outcomes of conventional amphotericin B-associated nephrotoxicity. Clin Infect Dis 35 : 120–127.
  21. Bates DW, Su L, Yu DT, Chertow GM, Seger DL, Gomes DR, Dasback EJ, Platt R, 2001. Mortality and costs of acute renal failure associated with amphotericin B therapy. Clin Infect Dis 32 : 686–693.
  22. Heidemann H, Gerkens G, Spickard W, Jackson E, Branch R, 1983. Amphotericin B nephrotoxicity in humans decreased by salt repletion. Am J Med 75 : 704–710.
  23. Branch R, 1988. Prevention of amphotericin B-induced renal impairment: a review on the use of sodium supplementation. Arch Intern Med 148 : 2389–2394.
  24. Girmenia C, Cimino G, Di Cristofano F, Micozzi A, Gentile G, Martino P, 2005. Effects of hydration with salt repletion on renal toxicity of conventional amphotericin B empirical therapy: a prospective study in patients with hematological malignancies. Support Care Cancer 13 : 987–992.
  25. Girmenia C, Gentile G, Micozzi A, Martino P, 2001. Nephrotoxicity of amphotericin B deoxycholate. Clin Infect Dis 33 : 915–916.
  26. Mayer J, Doubek M, Doubek J, Horky D, Scheer P, Stepánek M, 2002. Reduced nephrotoxicity of conventional amphotericin B therapy after minimal nephroprotective measures: animal experiments and clinical study. J Infect Dis 186 : 379–388.
  27. Holler B, Omar S, Farid M, Patterson M, 2004. Effects of fluid and electrolyte management on amphotericin B-induced nephrotoxicity among extremely low birth weight infants. Pediatrics 113 : 608–616.
  28. Bernardo J, Murakami S, Branch R, Sabra R, 1995. Potassium depletion potentiates amphotericin B-induced toxicity to renal tubules. Nephron 70 : 235–241.
  29. Eriksson U, Seifert B, Schaffner A, 2001. Comparison of effects of amphotericin B deoxycholate infusion over 4 or 24 hours: randomised controlled trial. BMJ 322 : 1–6.
  30. Imhof A, Waler R, Schaffner A, 2003. Continuous infusion of escalated doses of amphotericin B deoxycholate: an open-label observational study. Clin Infect Dis 36 : 943–951.
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  • Received : 28 Jul 2006
  • Accepted : 07 Aug 2006

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