Continuous infusion of escalated doses of amphotericin B deoxycholate: an open-label observational study

Clin Infect Dis. 2003 Apr 15;36(8):943-51. doi: 10.1086/368312. Epub 2003 Apr 4.

Abstract

Amphotericin B deoxycholate (AmB-d) remains a mainstay of antifungal therapy for immunocompromised patients, despite being associated with significant therapy-related toxicity. Because continuous infusion of AmB-d is better tolerated than traditional administration over 2-6 hours, we evaluated escalation of the AmB-d dose in 33 patients (31 of whom were neutropenic), for whom the initial dosage of AmB-d (1 mg/kg/day) was gradually increased to 2.0 mg/kg/day when renal function remained stable and the drug was tolerated. Dose escalation was possible without delay in 28 patients. Median duration of AmB-d therapy was 16 days (range, 7-72 days). Infusion-related reactions accompanied <18% of AmB-d infusions. Twenty-seven patients had a decrease in creatinine clearance while receiving AmB-d therapy. A >2-fold decrease in creatine clearance was observed in 5 patients, and the decrease was dose-limiting in only 1 patient; no dialysis was required. In conclusion, continuous infusion of AmB-d escalated to 2.0 mg/kg/day seems not to cause additional impairment of vital organ functions and to be well tolerated by most patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amphotericin B / administration & dosage*
  • Amphotericin B / adverse effects
  • Amphotericin B / therapeutic use
  • Cohort Studies
  • Deoxycholic Acid / administration & dosage*
  • Deoxycholic Acid / adverse effects
  • Deoxycholic Acid / analogs & derivatives*
  • Deoxycholic Acid / therapeutic use
  • Drug Combinations
  • Female
  • Humans
  • Immunocompromised Host
  • Infusion Pumps / adverse effects
  • Male
  • Middle Aged
  • Mycoses / drug therapy*
  • Nausea / etiology
  • Neutropenia / etiology
  • Opportunistic Infections / drug therapy*
  • Treatment Outcome

Substances

  • Drug Combinations
  • Deoxycholic Acid
  • Amphotericin B
  • amphotericin B, deoxycholate drug combination