Abstract
Background: Amphotericin B is the agent of choice for most invasive fungal infections in critically ill patients. It is associated with at least a 50% incidence of nephrotoxicity, despite prophylactic measures such as sodium loading. Newer formulations of amphotericin B are available but are costly and have unknown bioavailability in critically ill patients. Previous trials in neutropenic and critically ill patients have demonstrated that mixing amphotericin B with 20% lipid solution (Intralipid; Clintec Nutrition, Deerfield, Ill) may decrease nephrotoxicity. Methods: In this randomized, prospective clinical trial, patients with positive fungal blood cultures, tracheal/sputum cultures or peritoneal cavity cultures were randomized to receive either 0.5 mg/kg per day of amphotericin B dextrose or 1.0 mg/kg per day of amphotericin B lipid emulsion. Duration of therapy was determined by the primary care team. Weekly 24-hour creatinine clearance was measured until 2 weeks after amphotericin B therapy was completed. Results: The two groups were similar based on age, white blood cell count, serum creatinine, and creatinine clearance at the beginning of therapy. The group receiving amphotericin B lipid emulsion had significantly less decrease in creatinine clearance compared with controls, despite receiving significantly more amphotericin B. Conclusion: Amphotericin B lipid emulsion can be given at a higher total cumulative dose than amphotericin B dextrose with less nephrotoxicity.
Original language | English (US) |
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Pages (from-to) | 336-340 |
Number of pages | 5 |
Journal | Journal of Trauma - Injury, Infection and Critical Care |
Volume | 47 |
Issue number | 2 |
DOIs | |
State | Published - Aug 1999 |
Externally published | Yes |
Keywords
- Amphotericin B
- Critical illness
- Fungal infections
- Fungemia
- Nephrotoxicity
- Sepsis
ASJC Scopus subject areas
- Surgery