Premium
Retrospective Analysis of the Dosage of Amphotericin B Lipid Complex for the Treatment of Invasive Fungal Infections
Author(s) -
Linden Peter,
Lee Lily,
Walsh Thomas J.
Publication year - 1999
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.19.16.1261.30870
Subject(s) - amphotericin b , medicine , dose , nephrotoxicity , creatinine , retrospective cohort study , dosing , mycosis , surgery , gastroenterology , antifungal , toxicity , dermatology
Study Objective . To understand the relationship between dosage and therapeutic response of amphotericin B lipid complex (ABLC) by analyzing underlying diseases, types of infections, and therapeutic outcomes with different dosages as second‐line antifungal therapy. Design . Retrospective analysis of low‐dose (initial dose ≤ 3 mg/kg) ABLC from three open‐label, clinical, second‐line treatment studies. Setting . Centers in the United States (204), Canada (3), Australia (1), Mexico (1), and The Netherlands (1). Patients . Five hundred fifty‐one patients (5 enrolled twice) with invasive fungal infections, of whom 289 failed and 267 were intolerant to conventional antifungal therapy. Interventions . Patients were to receive the recommended dosage of ABLC 5 mg/kg/day, with dosage reduction for markedly increased serum creatinine. The duration of treatment was 4 weeks; therapy could be extended if the investigator considered additional treatment necessary. Measurements and Main Results . Seventy‐three patients (13%) received ABLC 3 mg/kg/day (low dosage) instead of the protocol‐recommended 5 mg/kg/day. Response was 65% and 56%, respectively. Logistic regression analysis revealed that the following patients are most likely to start therapy at the lower dosage: those with candidiasis and other yeast infections, patients with nephrotoxicity due to prior amphotericin B, and those with underlying conditions other than hematologic malignancy. Conclusion . These results suggest that ABLC 3 mg/kg/day may be effective in treating patients with candidiasis who do not have hematologic malignancy.