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Experience with Community‐Based Amphotericin B Infusion Therapy
Author(s) -
Malani Preeti N.,
DePestel Daryl D.,
Riddell James,
Bickley Susan,
Klein Lisa R.,
Kauffman Carol A.
Publication year - 2005
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.25.5.690.63591
Subject(s) - amphotericin b , medicine , nephrotoxicity , amphotericin b deoxycholate , adverse effect , concomitant , creatinine , blood urea nitrogen , intensive care medicine , surgery , toxicity , antifungal , dermatology , caspofungin
Study Objectives. To identify the types and frequencies of adverse events associated with community‐based amphotericin B infusion therapy. A second objective was to validate the effectiveness of a monitoring system, based on guidelines from the Infectious Diseases Society of America (IDSA). Design. Retrospective medical record review. Setting. Outpatient clinic at a tertiary care center. Patients. One hundred five patients who received amphotericin B therapy from a home care provider between January 1997 and July 2002. Measurements and Main Results A total of 113 courses of amphotericin B formulations were administered: liposomal amphotericin B, 41 courses (36%), amphotericin B deoxycholate, 31 courses (27%), amphotericin B lipid complex, 31 courses (27%), and amphotericin B colloidal dispersion, 3 courses (3%); an additional 7 courses consisted of sequential therapy with two different formulations. Nephrotoxicity was associated with 46 (41%) courses, electrolyte abnormalities with 40 (35%) courses, venous access device complications with 12 (11%) courses, and infusion reactions with 13 (12%) courses. Nephrotoxicity occurred most frequently in adults aged 60 years or older, solid organ transplant recipients, and those receiving concomitant cyclosporine. Only two (12%) of 17 courses in children younger than 13 years were associated with nephrotoxicity. Thirteen of all 113 courses resulted in patients requiring hospital admission due to their adverse events. Monitoring of electrolyte, serum creatinine, and blood urea nitrogen levels 2 or 3 times/week was adequate for identifying these events. Conclusion. Significant rates of adverse events occurred in patients who received community‐based amphotericin B infusion therapy. A monitoring system based on IDSA guidelines was effective in facilitating the detection and management of these adverse events.