Burden of acute kidney injury in HIV patients under deoxycholate amphotericin B therapy for cryptococcal meningitis and cost-minimization analysis of amphotericin B lipid complex

2018 ◽  
Vol 57 (3) ◽  
pp. 265-269
Author(s):  
Felipe Francisco Tuon ◽  
Khaiany Lino Florencio ◽  
Jaime L Rocha
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Cost Minimization ◽  
Kidney Injury ◽  
Hiv Patients ◽  
Lipid Complex ◽  
Cost Minimization Analysis ◽  
Amphotericin B Lipid Complex

scholarly journals Evaluation of Amphotericin B Lipid Formulations for Treatment of Severe Coccidioidomycosis

2018 ◽  
Vol 62 (7) ◽  
pp. e02293-17 ◽  
Author(s):  
Ritam Sidhu ◽  
David B. Lash ◽  
Arash Heidari ◽  
Piruthiviraj Natarajan ◽  
Royce H. Johnson
Keyword(s):  
Amphotericin B ◽  
Complement Fixation ◽  
Kidney Injury ◽  
Outcome Data ◽  
Inclusion Criteria ◽  
Lipid Complex ◽  
Meningeal Involvement ◽  
Amphotericin B Lipid Complex ◽  
Lipid Formulations

ABSTRACT Patients with severe coccidioidomycosis infections are often treated with either amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L-AmB). Outcome data with these agents in severe coccidioidomycosis cases are currently lacking. The purpose of this study is to evaluate the efficacy and toxicity of ABLC and L-AmB in treating severe coccidioidomycosis. A retrospective pre-post study design was employed. Chart reviews were completed from 1 January 2005 to 31 December 2014 for all patients who received lipid-based amphotericin B. Inclusion criteria included having a follow-up complement fixation (CF) titer or a treatment emergent adverse event (TEAE) prior to follow-up. Patients with meningeal involvement and pregnant patients were excluded. Treatment outcomes were assessed based on documented completion of therapy as well on symptoms, complement fixation titer, and changes to laboratory monitoring parameters. A total of 108 patients were identified, 69 of whom met the inclusion criteria. There were no statistical differences in demographics or disease burden in those that received ABLC and those that received L-AmB, except that those who received L-AmB were more likely to have previously diagnosed chronic kidney disease (nL-AmB = 4, 12.5% vs nABLC = 0, 0.0%; P = 0.042) and to have a lower creatinine clearance at the start of therapy (L-AmB = 79.6 mg/dl versus ABLC = 100.4 mg/dl; P = 0.008). Successful treatment was achieved in 27 (73.0%) of ABLC patients and 22 (68.8%) of L-AmB patients (P = 0.700). Amphotericin B was discontinued due to documented completion of therapy for 17 (45.9%) ABLC patients and 18 (56.3%) L-AmB patients (P = 0.553). Acute kidney injury (AKI) was the documented reason of treatment cessation for 10 (27.0%) ABLC and 1 (3.1%) L-AmB patient (P = 0.007). ABLC and L-AmB both appear to be equally efficacious in the treatment of severe coccidioidomycosis. L-AmB may have less renal toxicity than ABLC and may be the preferred agent in baseline renal impairment.

scholarly journals Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Charlotte Schutz ◽  
David R. Boulware ◽  
Katherine Huppler-Hullsiek ◽  
Maximilian von Hohenberg ◽  
Joshua Rhein ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Cd4 Count ◽  
Urine Ngal ◽  
Urine Protein ◽  
Immunodeficiency Virus

Abstract Background Cryptococcus is the most common etiology of adult meningitis in Africa. Amphotericin B deoxycholate remains paramount to treatment, despite toxicities, including acute kidney injury (AKI). We assessed the ability of the following urine markers to predict AKI in patients who received amphotericin B: urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), tissue inhibitor of metalloproteinases-2 (TIMP-2), and protein. Methods One hundred and thirty human immunodeficiency virus (HIV)–infected participants with cryptococcal meningitis were enrolled and received amphotericin and fluconazole for 2 weeks. We defined AKI as glomerular filtration rate (GFR) < 60 mL/min/1.73 m2; measured urine NGAL, CysC, TIMP-2, and protein; and explored AKI incidence, risk factors, and associations with mortality using Cox proportional hazards models. Results Participants were 48% female with a median age of 35 years, a median CD4 count of 21 cells/μL, and 44% died within 12 months. Incident AKI occurred in 42% and was associated with mortality (adjusted hazard ratio [aHR] = 2.8; P < .001). Development of AKI was associated with female sex (P = .04) and with higher CD4 count (49 vs 14 cells/μL; P < .01). Urine protein level in the highest quartile independently predicted AKI and mortality (aHR = 1.64, P = .04; aHR = 2.13, P = .02, respectively). Urine NGAL levels in the highest quartile independently predicted AKI (aHR = 1.65; P = .04). Conclusions Acute kidney injury occurred in 42% of patients, and AKI was associated with mortality. Urine biomarkers, specifically urine protein, may be useful for antecedent prediction of amphotericin-associated AKI but need further evaluation.

scholarly journals Amphotericin B Lipid Complex Compared with Amphotericin B in the Treatment of Cryptococcal Meningitis in Patients with AIDS

1996 ◽  
Vol 22 (2) ◽  
pp. 308-314 ◽  
Author(s):  
P. K. Sharkey ◽  
J. R. Graybill ◽  
E. S. Johnson ◽  
S. G. Hausrath ◽  
R. B. Pollard ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Lipid Complex ◽  
Amphotericin B Lipid Complex

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.

Amphotericin B Lipid Complex

Drugs ◽  
2004 ◽  
Vol 64 (17) ◽  
pp. 1905-1911 ◽  
Author(s):  
David R Goldsmith ◽  
Caroline M Perry
Keyword(s):  
Amphotericin B ◽  
Lipid Complex ◽  
Amphotericin B Lipid Complex

scholarly journals Combination Echinocandin-Polyene Treatment of Murine Mucormycosis

2008 ◽  
Vol 52 (4) ◽  
pp. 1556-1558 ◽  
Author(s):  
Ashraf S. Ibrahim ◽  
Teclegiorgis Gebremariam ◽  
Yue Fu ◽  
John E. Edwards ◽  
Brad Spellberg
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Class Effect ◽  
Lipid Complex ◽  
Enhanced Activity ◽  
Amphotericin B Lipid Complex ◽  
Disseminated Mucormycosis

ABSTRACT We previously found that caspofungin synergized with amphotericin B lipid complex in treating murine mucormycosis. We now report a similarly enhanced activity of liposomal amphotericin combined with micafungin or anidulafungin in mice with disseminated mucormycosis. The efficacy of combination echinocandin-polyene therapy for mucormycosis is a class effect.

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