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) |
|---|---|
| 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 |
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Keywords
- Amphotericin B
- Critical illness
- Fungal infections
- Fungemia
- Nephrotoxicity
- Sepsis
ASJC Scopus subject areas
- Surgery
Cite this
A randomized prospective trial of amphotericin B lipid emulsion versus dextrose colloidal solution in critically ill patients. / Barquist, Erik; Fein, Eleanor; Shadick, David; Johnson, Joseph; Clark, John; Shatz, David V.
In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 47, No. 2, 08.1999, p. 336-340.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A randomized prospective trial of amphotericin B lipid emulsion versus dextrose colloidal solution in critically ill patients
AU - Barquist, Erik
AU - Fein, Eleanor
AU - Shadick, David
AU - Johnson, Joseph
AU - Clark, John
AU - Shatz, David V
PY - 1999/8
Y1 - 1999/8
N2 - 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.
AB - 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.
KW - Amphotericin B
KW - Critical illness
KW - Fungal infections
KW - Fungemia
KW - Nephrotoxicity
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=0032811743&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032811743&partnerID=8YFLogxK
U2 - 10.1097/00005373-199908000-00020
DO - 10.1097/00005373-199908000-00020
M3 - Article
C2 - 10452470
AN - SCOPUS:0032811743
VL - 47
SP - 336
EP - 340
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 2
ER -