Uso de anfotericina B deoxicolato y sus reacciones adversas en un hospital universitario en Chile

Abstract

Amphotericin B deoxycholate prescription and adverse events in a Chilean university hospitalAmphotericin B deoxycholate is associated with infusion-related toxicity and renal toxicity. Purpose: To evaluate medical indications of this compound in a tertiary care center, analyze adverse reactions, infusion protocols and outcome of treated patients. Patients and methods: Retrospective analysis of 39 treatments indicated in 33 patients during 2007, exploring indications, infusion protocols and renal protective measures, infusion-related adverse reactions, nephrotoxicity, hypokalemia and outcomes. Results: On average, therapy lasted 12 days (2 to 39) and reached 600 mg of accumulated dose (100 to 1950) respectively. 24-hours infusions were applied in 63.2% of prescriptions and 35.9% received a 4-6 hour infusion schedule. In addition, 36.8% received daily a saline infusion before amphotericin. Adverse reactions were observed in 40% of treatments, predominating fever (25%). Nonetheless, nephrotoxicity was infrequent (9.4%), of low magnitude, only affecting patients without previous renal disease, and not requiring dialysis. Hypokalemia developed in 21.6% of treatments. More than half of medical indications were empirical (59%), for presumed infections either by filamentous fungi or yeasts. In the subgroup with microbiological information, main indications were invasive aspergillosis (15.4% of total), systemic candidiasis (12.8%) or meningeal cryptococcosis (10.3%). A favorable response was registered in 41%, and only 48.5% of patients survived. In a multivariate analysis, only age > 60 years remained as an independent factor for developing infusion-related adverse reactions. In the same manner, a SOFA score > 3 and corticosteroids administration at the same time than amphotericin B, were independently associated to a fatal outcome. Conclusion: infusion-related adverse reactions are frequent during amphotericin B deoxycholate therapy, but renal toxicity is occasionally observed. Amphotercin B was used mainly as empirical therapy in this study.

Enhanced antifungal effects of amphotericin B-TPGS-b-(PCL-ran-PGA) nanoparticles in vitro and in vivo

“…5 The lipid formulations of AMB may alleviate the toxicity and increase the bioavailability of AMB. 5,6 Nevertheless, the high cost of these formulations puts them beyond the reach of most of patients with fungal infection.…”

“…However, this reduces the tissue fungal burden by no more than 30% as compared with controls, indicating limited in vivo efficacy of these formulations. [5][6][7] In addition, the stability, tissue permeability, degradation rate, and toxicity of NPs themselves are also concerns in this field. [8][9][10] The recently developed diblock copolymer D-α-tocopheryl polyethylene glycol 1000 succinate-b-poly(ε-caprolactone-ran-glycolide) (TPGS-b-(PCL-ran-PGA) [hereafter, referred to as PLGA-TPGS]) has received special attention as a promising antimicrobial agent, due to its good biocompatibility and biodegradability.…”

Pharmacovigilance study of amphotericin B for mucormycosis in post-COVID and non-COVID patients at a tertiary care hospital in Eastern India

“…The ADR spectrum we encountered was in line with the known toxicity profile of the drug. [ 15 16 ] Hypokalemia, infusion-related reactions, anemia, hypomagnesemia, raised serum creatinine, and AKI were encountered at a frequency over 5%. Fortunately, most could be managed with supportive treatment, and although some of the ADRS were deemed serious, deaths in our study participants were attributed to disease severity rather than drug toxicity.…”

“…Although the spectrum revealed no surprise, the overall frequency of ADR was high compared with some earlier studies. [ 15 16 ] This may logically be attributed to the longer duration of drug use (69% for at least 2 and 30% for at least 3 weeks) in mucormycosis cases compared to other indications for amphotericin B usage.…”

Mucormicosis: El Desafío Emergente en la Salud Global y su Relación con la Pandemia de COVID-19

“…La terapia antifúngica, principalmente con anfotericina B, puede requerir periodos prolongados, y en algunos casos, se considera la terapia de mantenimiento. La monitorización continua es crucial para ajustar la duración según la respuesta del paciente (27).…”