Oral Rehydration Solution to Prevent Nephrotoxicity of Amphotericin B

Abstract

Treatment with amphotericin B deoxycholate (AB) is associated with dose-related nephrotoxicity. We conducted an open and randomized trial to evaluate the efficacy of an oral rehydration solution (ORS) to prevent nephrotoxicity of AB, compared with an intravenous saline solution (SS). Adult patients with mucosal leishmaniasis in whom AB was indicated received either three liters or ORS or one liter of SS. Renal function tests were performed at baseline and during treatment. Forty-eight patients were included (ORS = 25, SS = 23). No difference was observed in serum creatinine, creatinine clearance, serum urea, and serum sodium values during treatment, but serum potassium values were lower in the SS group than in the ORS group (P < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, P = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.

American cutaneous leishmaniasis in infancy and childhood

“…111 It is important to quote that the use of intravenous and oral rehydration solutions has proven to be effective in preventing both glomerular damage and hypokalemia during the administration of amphotericin B. 112 Although there is scarce evidence on which to make reliable considerations on azole therapy, ketoconazole 100 mg/d p.o.…”

Diagnóstico y tratamiento de la neutropenia febril en niños con cáncer: Consenso de la Sociedad Latinoamericana de Infectología Pediátrica

“…Los efectos adversos de anfotericina B deoxicolato son comunes y están relacionados con la velocidad de la infusión, siendo la toxicidad renal el efecto adverso más frecuente. Estos efectos se pueden prevenir o aminorar realizando una infusión en 4-6 horas, aportando hidratación previa con solución salina (NaCl al 9‰) y efectuando premedicación con anti infl amatorios no esteroidales o usando hidrocortisona antes y/o durante la infusión 141,142 . Las combinaciones de antifúngicos, aunque se usan en la práctica clínica para pacientes con EFI e inmunocompromiso profundo, no se recomiendan rutinariamente 143,144 .…”

Prevalence and Hospital Management of Amphotericin B Deoxycholate-Related Toxicities during Treatment of HIV-Associated Cryptococcal Meningitis in South Africa

“…Physicians may be reluctant to use KCl supplementation for fear of hyperkalemia and its complications. However, the high prevalence of hypokalemia during AmBd treatment in this and other studies suggests that this concern is unfounded, especially if laboratory tests are ordered as recommended [ 16 , 18 , 19 ]. Anemia is a common finding among HIV-infected hospitalized patients and a common toxicity associated with AmBd therapy [ 16 , 26 ].…”

“…An observational study from Kenya reported nephrotoxicity in 59%, hypokalemia in 93%, and hypomagnesaemia in 80% of 70 patients with CM treated with AmBd[ 15 ]. In clinical trial settings with standardized pre-hydration and electrolyte supplementation regimens, 10% of patients still develop nephrotoxicity and 6% develop hypokalemia [ 16 – 18 ]. A recent study reported improved 30-day survival following proactive fluid and electrolyte management of patients with CM treated with AmBd.…”