Continuous infusion of amphotericin B: preliminary experience at Faculdade de Medicina da Fundação ABC

Abstract

CONTEXT AND OBJECTIVE: Intravenous amphotericin B deoxycholate (AmB-D) infusions, usually given over 4 hours, frequently induce nephrotoxicity and undesirable infusion-related side effects such as rigors and chills. There is evidence in the literature that the use of AmB-D in the form of continuous 24-hour infusion is less toxic than the usual four-hour infusion of this drug. Our objective was to evaluate the efficacy and safety of continuous infusion of AmB-D for the treatment of persistent fever in neutropenic patients with hematological malignancies after chemotherapy. DESIGN AND SETTING: Observational retrospective analysis of our experience with continuous infusion of AmB-D, at Faculdade de Medicina da Fundação ABC and Hospital Estadual Mário Covas in Santo André. METHODS: From October 2003 to May 2004, 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous infusion of AmB-D. RESULTS: The median dose of AmB-D was 0.84 mg/kg/day (0.33 to 2.30 mg/kg/day). Concomitant use of nephrotoxic medications occurred in 92% of the cycles. Nephrotoxicity occurred in 30.76% of the cycles, hypokalemia in 16.67%, hepatotoxicity in 30% and adverse infusion-related events in 23%. All patients survived for at least seven days after starting continuous infusion of AmB-D, and clinical resolution occurred in 76% of the cycles. CONCLUSIONS: Continuous infusion of AmB-D can be used in our Institution as an alternative to the more toxic four-hour infusion of AmB-D and possibly also as an alternative to the more expensive liposomal formulations of the drug.

Continuous infusion of amphotericin B deoxycholate: an innovative, low-cost strategy in antifungal treatment

“…A retrospective study analysed data from 12 patients with febrile neutropenia requiring antifungal therapy, who were treated with a 24‐h continuous infusion of amphotericin B deoxycholate 2 . Only three of these patients presented proven fungal infection.…”

“…Amphotericin B deoxycholate is presently the most important of antifungal agents especially in institutions of healthcare settings with limited resources. However, considerable toxicity is frequently associated with its use, especially in the kidneys 1–3 …”

“…However, considerable toxicity is frequently associated with its use, especially in the kidneys. [1][2][3] The development of new agents such as amphotericin with lipid formulations, echinocandins, voriconazole and other azolic derivatives promoted alternatives to amphotericin B deoxycholate. However, because of the high cost of these new drugs, their use is difficult in a scenario of limited resources.…”

Pesquisa clínica conduzida por estudantes de medicina: seu potencial para o aprendizado e para a produção científica nacional

“…Geralmente, privilegiamos trabalhos que envolvam questionários para aplicação em grupos de pacientes ou médicos e utilizados em 3 a 4 meses de trabalho de campo, que se inicia tão logo seja obtida a aprovação do projeto elaborado e escrito pelos estudantes juntamente com o docente pelo comitê de ética e pesquisa institucional. Após a coleta e análise dos dados (feitas pelos próprios alunos), cada grupo redige um manuscrito que é submetido para congressos e para publicação em periódicos nacionais [1][2][3][4] e, algumas vezes também, internacionais [5][6][7] . Nossos estudantes aprendem assim a pesquisar a literatura, escrever projetos, se familiarizam com aspectos éticos relacionados à pesquisa clínica, lidam com coleta e análise estatística de dados, participam da elaboração de um manuscrito para publicação e também adquirem prática em apresentar oralmente e serem argüidos acerca de seus trabalhos em congressos médicos universitários ou de especialidades.…”

A Medical Student-Staffed Outpatient Oncology Clinic: A 10-Year Brazilian Experience

“…Some of the resulting papers have already published in peer reviewed journals. [3][4][5][6][7][8][9] By April 2006, 95 medical students have participated in this activity, 89% of them for 2 or more years. Of the students, 70% reported that this activity contributed significantly to their ability to read and understand medical papers, whereas and 59% reported that they improved their scientific writing.…”