Role of ethylene diamine tetra-acetic acid (EDTA) in catheter lock solutions: EDTA enhances the antifungal activity of amphotericin B lipid complex against Candida embedded in biofilm

2008 ◽  
Vol 32 (6) ◽  
pp. 515-518 ◽  
Author(s):  
Issam I. Raad ◽  
Ray Y. Hachem ◽  
Hend A. Hanna ◽  
Xiang Fang ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Acetic Acid ◽  
Antifungal Activity ◽  
Amphotericin B ◽  
Ethylene Diamine ◽  
Lipid Complex ◽  
Catheter Lock ◽  
Amphotericin B Lipid Complex

scholarly journals In Vitro and In Vivo Antifungal Activity of Amphotericin B Lipid Complex: Are Phospholipases Important?

1998 ◽  
Vol 42 (4) ◽  
pp. 767-771 ◽  
Author(s):  
Christine E. Swenson ◽  
Walter R. Perkins ◽  
Patricia Roberts ◽  
Imran Ahmad ◽  
Rachel Stevens ◽  
...  
Keyword(s):  
Antifungal Activity ◽  
Amphotericin B ◽  
Vascular Tissue ◽  
Therapeutic Index ◽  
Test Material ◽  
Lipid Complex ◽  
In Vitro Susceptibility ◽  
Amphotericin B Lipid Complex

ABSTRACT Amphotericin B lipid complex for injection (ABLC) is a suspension of amphotericin B complexed with the lipidsl-α-dimyristoylphosphatidylcholine (DMPC) andl-α-dimyristoylphosphatidylglycerol. ABLC is less toxic than amphotericin B deoxycholate (AmB-d), while it maintains the antifungal activity of AmB-d. Active amphotericin B can be released from ABLC by exogenously added (snake venom, bacteria, orCandida-derived) phospholipases or by phospholipases derived from activated mammalian vascular tissue (rat arteries). Such extracellular phospholipases are capable of hydrolyzing the major lipid in ABLC. Mutants of C. albicans that were resistant to ABLC but not AmB-d in vitro were deficient in extracellular phospholipase activity, as measured on egg yolk agar or as measured by their ability to hydrolyze DMPC in ABLC. ABLC was nevertheless effective in the treatment of experimental murine infections produced by these mutants. Isolates of Aspergillus species, apparently resistant to ABLC in vitro (but susceptible to AmB-d), were also susceptible to ABLC in vivo. We suggest that routine in vitro susceptibility tests with ABLC itself as the test material may not accurately predict the in vivo activity of ABLC and that the enhanced therapeutic index of ABLC relative to that of AmB-d in vivo may be due, in part, to the selective release of active amphotericin B from the complex at sites of fungal infection through the action of fungal or host cell-derived phospholipases.

Comparative in vitro Antifungal Activity of Amphotericin B Lipid Complex, Amphotericin B and Fluconazole

Chemotherapy ◽  
2000 ◽  
Vol 46 (4) ◽  
pp. 235-244 ◽  
Author(s):  
Alfonso-Javier Carrillo-Muñoz ◽  
Guillermo Quindós ◽  
Cristina Tur ◽  
Maite Ruesga ◽  
Rocío Alonso ◽  
...  
Keyword(s):  
Antifungal Activity ◽  
Amphotericin B ◽  
Lipid Complex ◽  
Amphotericin B Lipid Complex ◽  
In Vitro Antifungal Activity

scholarly journals Dose-Dependent Pharmacokinetics of Amphotericin B Lipid Complex in Rabbits

2000 ◽  
Vol 44 (8) ◽  
pp. 2068-2076 ◽  
Author(s):  
Thomas J. Walsh ◽  
Andre J. Jackson ◽  
James W. Lee ◽  
Michael Amantea ◽  
Tin Sein ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Fungal Infections ◽  
Rabbit Model ◽  
Time Dependent ◽  
Antifungal Compound ◽  
Lipid Complex ◽  
Detailed Model ◽  
Amphotericin B Lipid Complex ◽  
Cellular Components

ABSTRACT Amphotericin B lipid complex (ABLC) was recently approved by the Food and Drug Administration for treatment of patients with invasive fungal infections who are intolerant of or refractory to conventional amphotericin B therapy. Little is known, however, about the pharmacokinetics of this new antifungal compound. We therefore investigated the pharmacokinetics of ABLC in comparison with those of conventional desoxycholate amphotericin B (DAmB) in rabbits. The pharmacokinetics of DAmB in a rabbit model were similar to those previously reported in humans. The pharmacokinetics of ABLC differed substantially from those of DAmB. Plasma amphotericin B levels following ABLC administration were 10 times lower than those following administration of an equal dosage of DAmB. The levels of ABLC in whole blood were approximately 40 times greater than those in plasma. The ABLC model differed from the DAmB model by (i) a dose- and time-dependent uptake and return between the plasma compartment and apparent cellular components of the blood-sediment compartment and (ii) time-dependent tissue uptake and return to plasma from serially connected compartments. Following infusion of ABLC, there was a nonlinear uptake into the apparent cellular components of the blood-sediment compartment. This uptake was related to the reciprocal of the integral of the total amount of drug infused (i.e., the more drug infused the greater the fractional uptake between 0.5 and 5 mg/kg of body weight for ABLC). The transfer of drug from plasma to the cellular components of the blood-sediment compartment resulted in initial uptake followed by rapid redistribution back to the plasma. The study describes a detailed model of the pharmacokinetics of ABLC and characterizes a potential role of the cellular components of the blood-sediment compartment in the distribution of this new antifungal compound in tissue.

Two-year Longitudinal Evaluation of Amphotericin B Lipid Complex Injection in a Tertiary Care Medical Center

2000 ◽  
Vol 35 (2) ◽  
pp. 176-181 ◽  
Author(s):  
Leanne D. Kennedy ◽  
Julie F. Connelly ◽  
Kevin M. Kuzma
Keyword(s):  
Serum Creatinine ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Serum Creatinine Concentration ◽  
Creatinine Concentration ◽  
Lipid Complex ◽  
Tertiary Care Medical Center ◽  
Amphotericin B Lipid Complex ◽  
The Mean

A 2-year concurrent drug use evaluation was conducted in 156 patients to determine whether Abelcet (amphotericin B lipid complex injection) was being prescribed according to institution-approved guidelines and to characterize the patient population receiving Abelcet. Eighty-nine patients (57%) had fungal infections documented by chest x-ray, computed tomography, or fungal cultures. Sixty-seven (43%) had clinically suspected fungal infections. The Abelcet mean dose by weight was 5 mg/kg/day (actual body weight). Seventy-one patients (46%) met the established guidelines for use; 85 (54%) did not. Premedication was given to 64% of the patients; only 15 patients (10%) experienced documented fever and chills. A total of 72 patients (46%) died during therapy. Of the 75 patients who completed therapy in the hospital, 41 were switched to conventional amphotericin B, fluconazole, or itraconazole following a decrease in serum creatinine concentration, and 34 did not receive further antifungal therapy. The mean length of Abelcet therapy was 11 days. The mean increase in serum creatinine concentration at discontinuation of therapy was 0.2 mg/dL. Continued monitoring of Abelcet use was recommended and established guidelines were reaffirmed. Hydration with normal saline before and after dosing was suggested to help improve renal function, and dopamine was recommended to increase renal blood flow.

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