TY - JOUR
T1 - Administration of amphotericin B in lipid emulsion decreases nephrotoxicity
T2 - Results of a prospective, randomized, controlled study in critically ill patients
AU - Sorkine, Patrick
AU - Nagar, Hagit
AU - Weinbroum, Avi
AU - Setton, Arick
AU - Israitel, Evjeni
AU - Scarlatt, Alexander
AU - Silbiger, Aviel
AU - Rudick, Valery
AU - Kluger, Yoram
AU - Halpern, Pinchas
PY - 1996/8
Y1 - 1996/8
N2 - Objectives: To evaluate the differences in efficacy and in clinical and biochemical tolerance to amphotericin B administered in a lipid emulsion compared with amphotericin B administered in 5% dextrose in water in the treatment of Candida albicans infection in intensive care unit (ICU) patients. Design: Prospective, controlled, randomized study, conducted during a 2.5-yr period, comparing the two treatment protocols. Setting: General ICU of a university-affiliated municipal hospital. Patients: Sixty consecutive critically ill patients with confirmed or suspected Candida infection. Interventions: Patients received amphotericin B (1 mg/kg/24 hrs), administered randomly in 5% dextrose in water (group A), or in lipid emulsion (20% Intralipid®) (group B). Measurements and Main Results: Clinical tolerance (fever, chills, hemodynamics), hepatorenal tolerance, and biological tolerance (serum electrolytes and coagulation profile) were evaluated. Patients receiving amphotericin B in lipid emulsion experienced a lower frequency rate of drug-associated fever (61.4% vs. 5.8%, p < .003) rigors (54% vs. 6.5%, p < .004), hypotension (17% vs. 0%), and nephrotoxicity (increase of serum creatinine concentration, 66.7% vs. 20%, p < .0002). Significant (264,500 ± 71,460 to 163,570 ± 34,450 mm3, p < .01) thrombocytopenia, not associated with active bleeding, occurred in patients receiving amphotericin B lipid in emulsion but not in patients receiving the drug in dextrose. Conclusions: Treatment with amphotericin B in a lipid emulsion when given to critically ill patients with Candida sepsis seems to be safer and as effective as the conventional mode of administration.
AB - Objectives: To evaluate the differences in efficacy and in clinical and biochemical tolerance to amphotericin B administered in a lipid emulsion compared with amphotericin B administered in 5% dextrose in water in the treatment of Candida albicans infection in intensive care unit (ICU) patients. Design: Prospective, controlled, randomized study, conducted during a 2.5-yr period, comparing the two treatment protocols. Setting: General ICU of a university-affiliated municipal hospital. Patients: Sixty consecutive critically ill patients with confirmed or suspected Candida infection. Interventions: Patients received amphotericin B (1 mg/kg/24 hrs), administered randomly in 5% dextrose in water (group A), or in lipid emulsion (20% Intralipid®) (group B). Measurements and Main Results: Clinical tolerance (fever, chills, hemodynamics), hepatorenal tolerance, and biological tolerance (serum electrolytes and coagulation profile) were evaluated. Patients receiving amphotericin B in lipid emulsion experienced a lower frequency rate of drug-associated fever (61.4% vs. 5.8%, p < .003) rigors (54% vs. 6.5%, p < .004), hypotension (17% vs. 0%), and nephrotoxicity (increase of serum creatinine concentration, 66.7% vs. 20%, p < .0002). Significant (264,500 ± 71,460 to 163,570 ± 34,450 mm3, p < .01) thrombocytopenia, not associated with active bleeding, occurred in patients receiving amphotericin B lipid in emulsion but not in patients receiving the drug in dextrose. Conclusions: Treatment with amphotericin B in a lipid emulsion when given to critically ill patients with Candida sepsis seems to be safer and as effective as the conventional mode of administration.
KW - Candida sepsis
KW - amphotericin B
KW - critically ill patients
KW - drug reactions
KW - fungal infections
KW - lipid emulsions
KW - pharmacology
KW - renal failure
KW - thrombocytopenia
UR - http://www.scopus.com/inward/record.url?scp=9344255433&partnerID=8YFLogxK
U2 - 10.1097/00003246-199608000-00007
DO - 10.1097/00003246-199608000-00007
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C2 - 8706484
AN - SCOPUS:9344255433
SN - 0090-3493
VL - 24
SP - 1311
EP - 1315
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 8
ER -