scholarly journals Short-Course Rather Than Low-Dose Amphotericin B May Exert Potential Influence on Mortality in Cryptococcal Meningitis Patients Treated With Amphotericin B Plus Flucytosine Alone or in Combination With Fluconazole

2019 ◽  
Vol 10 ◽  
Author(s):  
Lijun Xu ◽  
Ran Tao ◽  
Jingjing Wu ◽  
Xiahong Dai ◽  
Caiqin Hu ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Low Dose ◽  
Potential Influence ◽  
Short Course

Treatment of Candidosis in Severely Injured Adults with Short-course, Low-dose Amphotericin B

1990 ◽  
Vol 30 (12) ◽  
pp. 1521-1523 ◽  
Author(s):  
ALEXANDER S. ROSEMURGY ◽  
THOMAS F. DROST ◽  
CHRISTOPHER G. MURPHY ◽  
ROBERT E. KEARNEY ◽  
MICHAEL H. ALBRINK
Keyword(s):  
Amphotericin B ◽  
Low Dose ◽  
Severely Injured ◽  
Short Course

scholarly journals Short-Course Induction Treatment with Intrathecal Amphotericin B Lipid Emulsion for HIV Infected Patients with Cryptococcal Meningitis

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Manoranjan Midde ◽  
Raghavakalyan Pakam ◽  
Pradeep Sukumar Yalla ◽  
Praveen Kumar Naik ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Risk Reduction ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Lipid Emulsion ◽  
Absolute Risk ◽  
White Blood Cells ◽  
Sub Saharan Africa ◽  
Induction Treatment ◽  
Short Course

Cryptococcal meningitis (CM) is a common cause of death among HIV infected patients in developing countries, especially in sub-Saharan Africa. In this observational HIV cohort study in a resource-limited setting in India, we compared the standard two-week intravenous amphotericin B deoxycholate (AmBd) (Regimen I) with one week of intravenous AmBd along with daily therapeutic lumbar punctures and intrathecal AmB lipid emulsion (Regimen II) during the intensive phase of CM treatment. 78 patients received Regimen I and 45 patients received Regimen II. After adjustment for baseline characteristics (gender, age, altered mental status or seizures at presentation, CD4 cell count, white blood cells, cerebrospinal fluid white cells, and haemoglobin), the use of Regimen II was associated with a significant relative risk reduction in mortality (adjusted hazard ratio 0.4, 95% confidence interval, 0.22–0.76) and 26.7% absolute risk reduction (95% confidence interval, 9.9–43.5) at 12 weeks. The use of Regimen II resulted in lower costs of drugs and hospital admission days. Since the study is observational in nature, we should be cautious about our results. However, the good tolerability of intrathecal administration of AmB lipid emulsion and the clinically important mortality reduction observed with the short-course induction treatment warrant further research, ideally through a randomized clinical trial.

scholarly journals Amphotericin B for cryptococcal meningitis in HIV positive patients: Low dose versus high dose

2007 ◽  
Vol 11 (3) ◽  
pp. 112-116 ◽  
Author(s):  
S. Rajeshwari ◽  
Prabha M.R. Adhikari* ◽  
John T. Ramapuram* ◽  
Satish Rao* ◽  
M.R.S.M. Pai ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Low Dose ◽  
Hiv Positive ◽  
High Dose

scholarly journals HIV-associated Cryptococcal Meningitis: a Review of Novel Short-Course and Oral Therapies

2020 ◽  
Vol 12 (4) ◽  
pp. 422-437
Author(s):  
Letumile R. Moeng ◽  
James Milburn ◽  
Joseph N. Jarvis ◽  
David S. Lawrence
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Liposomal Amphotericin ◽  
Phase Iii ◽  
Induction Treatment ◽  
High Dose ◽  
Ongoing Research ◽  
Short Course ◽  
Incidence And Mortality ◽  
The Impact

Abstract Purpose of review HIV-associated cryptococcal meningitis remains a significant public health problem in parts of Africa and Asia and a major cause of AIDS-related mortality, accounting for 15% of all AIDS-related deaths worldwide. Cryptococcal meningitis is uniformly fatal if untreated, and access to antifungal therapy in regions with the highest burden is often limited. Outcomes with fluconazole monotherapy are poor, and induction treatment with amphotericin B and high-dose fluconazole for 2 weeks is associated with significant drug-related toxicities and prolonged hospital admissions. This review focuses on the potential of novel short-course and oral combination therapies for cryptococcal meningitis. Recent findings Recent clinical trials have shown that shorter courses of amphotericin, if paired with oral flucytosine, rather than fluconazole, can achieve non-inferior mortality outcomes. In addition, an oral combination of fluconazole and flucytosine is a potential alternative. Liposomal amphotericin B may further simplify treatment; it is associated with fewer drug-related toxicities, and a recent phase II randomised controlled trial demonstrated that a single, high dose of liposomal amphotericin is non-inferior to 14 standard daily doses at clearing Cryptococcus from cerebrospinal fluid. This has been taken forward to an ongoing phase III, clinical endpoint study. Summary The incidence and mortality associated with cryptococcal meningitis is still unacceptably high. There is evidence supporting the use of short-course amphotericin B and oral combination antifungal treatment regimens for cryptococcal meningitis (CM). Ongoing research into short-course, high-dose treatment with liposomal amphotericin may also help reduce the impact of this devastating disease.

Short course amphotericin B with high dose fluconazole for HIV-associated cryptococcal meningitis

2012 ◽  
Vol 64 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Conrad K. Muzoora ◽  
Taseera Kabanda ◽  
Giuseppina Ortu ◽  
John Ssentamu ◽  
Pasco Hearn ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
High Dose ◽  
Short Course

Granulocytopenia and Thrombocytopenia Associated with Combination Therapy of Amphotericin B and Low-Dose Flucytosine in a Patient with Cryptococcal Meningitis

DICP ◽  
1989 ◽  
Vol 23 (9) ◽  
pp. 672-674 ◽  
Author(s):  
Kunihiko Shindo ◽  
Tadaoki Mizuno ◽  
Yutaka Matsumoto ◽  
Yoshimi Hashimoto ◽  
Masanori Matsumura ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Combination Therapy ◽  
Amphotericin B ◽  
Lumbar Puncture ◽  
Cryptococcal Meningitis ◽  
Low Dose ◽  
Clinical Symptoms ◽  
Nuchal Rigidity ◽  
India Ink ◽  
Toxic Reactions

A patient was admitted complaining of fever and headache. He was suspected of meningitis due to nuchal rigidity, and a lumbar puncture was performed. The patient was diagnosed as having cryptococcal meningitis, as Cryptococcus neoformans was found in an India ink preparation of the cerebrospinal fluid. Both amphotericin B and low-dose flucytosine (50 mg/kg/d) were concomitantly administered to the patient and his clinical symptoms improved. However, the combination therapy induced granulocytopenia and thrombocytopenia, which resolved after discontinuance of the drugs. Amphotericin B alone failed to cause granulocytopenia or thrombocytopenia. These results suggest that the mechanisms of granulocytopenia and thrombocytopenia may be toxic reactions to flucytosine in the azotemic state caused by amphotericin B. Our report emphasizes the need for clinicians to monitor for granulocytopenia and thrombocytopenia in patients receiving treatment with both amphotericin B and flucytosine, even when flucytosine is administered in a low dose.

scholarly journals A phase II randomized controlled trial adding oral flucytosine to high-dose fluconazole, with short-course amphotericin B, for cryptococcal meningitis

AIDS ◽  
2012 ◽  
Vol 26 (11) ◽  
pp. 1363-1370 ◽  
Author(s):  
Arthur T. Jackson ◽  
Jesse C. Nussbaum ◽  
Jacob Phulusa ◽  
Dan Namarika ◽  
Maria Chikasema ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Amphotericin B ◽  
Phase Ii ◽  
Cryptococcal Meningitis ◽  
Controlled Trial ◽  
High Dose ◽  
Randomized Controlled ◽  
Short Course

scholarly journals Toxicity of Amphotericin B Deoxycholate-Based Induction Therapy in Patients with HIV-Associated Cryptococcal Meningitis

2015 ◽  
Vol 59 (12) ◽  
pp. 7224-7231 ◽  
Author(s):  
Tihana Bicanic ◽  
Christian Bottomley ◽  
Angela Loyse ◽  
Annemarie E. Brouwer ◽  
Conrad Muzoora ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Induction Treatment ◽  
Standardized Protocol ◽  
Short Course ◽  
Amphotericin B Deoxycholate ◽  
Intravenous Saline ◽  
Electrolyte Replacement ◽  
Grade Iii ◽  
Electrolyte Abnormalities

ABSTRACTAmphotericin B deoxycholate (AmBd) is the recommended induction treatment for HIV-associated cryptococcal meningitis (CM). Its use is hampered by toxicities that include electrolyte abnormalities, nephrotoxicity, and anemia. Protocols to minimize toxicity are applied inconsistently. In a clinical trial cohort of AmBd-based CM induction treatment, a standardized protocol of preemptive hydration and electrolyte supplementation was applied. Changes in blood counts, electrolyte levels, and creatinine levels over 14 days were analyzed in relation to the AmBd dose, treatment duration (short course of 5 to 7 days or standard course of 14 days), addition of flucytosine (5FC), and outcome. In the 368 patients studied, the hemoglobin levels dropped by a mean of 1.5 g/dl (95% confidence interval [CI], 1.0 to 1.9 g/dl) following 7 days of AmBd and by a mean of 2.3 g/dl (95% CI, 1.1 to 3.6 g/dl) after 14 days. Serum creatinine levels increased by 37 μmol/liter (95% CI, 30 to 45 μmol/liter) by day 7 and by 49 μmol/liter (95% CI, 35 to 64μmol/liter) by day 14 of AmBd treatment. Overall, 33% of patients developed grade III/IV anemia, 5.6% developed grade III hypokalemia, 9.5% had creatinine levels that exceeded 220 μmol, and 6% discontinued AmBd prematurely. The addition of 5FC was associated with a slight increase in anemia but not neutropenia. Laboratory abnormalities stabilized or reversed during the second week in patients on short-course induction. Grade III/IV anemia (adjusted odds ratio [aOR], 2.2; 95% CI, 1.1 to 4.3;P= 0.028) and nephrotoxicity (aOR, 4.5; 95% CI, 1.8 to 11;P= 0.001) were risk factors for 10-week mortality. In summary, routine intravenous saline hydration and preemptive electrolyte replacement during AmBd-based induction regimens for HIV-associated CM minimized the incidence of hypokalemia and nephrotoxicity. Anemia remained a concerning adverse effect. The addition of flucytosine was not associated with increased neutropenia. Shorter AmBd courses were less toxic, with rapid reversibility.

Voriconazole combined with low-dose amphotericin B liposome for treatment of cryptococcal meningitis

2016 ◽  
Vol 48 (7) ◽  
pp. 563-565 ◽  
Author(s):  
Shan-Shan Li ◽  
Xin-Yue Tang ◽  
Sheng-Guo Zhang ◽  
Shun-Lan Ni ◽  
Nai-Bin Yang ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Low Dose
Sign in / Sign up

Export Citation Format

Share Document