Continuous and 4 h infusion of amphotericin B: a comparative study involving high-risk haematology patients

• Published in: Journal of antimicrobial chemotherapy Vol. 54; no. 4; pp. 803 - 808
• Main Authors: Peleg, A. Y., Woods, M. L.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2004; Oxford Publishing Limited (England)
• Subjects: Amphotericin B - administration & dosage; Amphotericin B - adverse effects; Amphotericin B - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; antifungal agents; Antifungal Agents - administration & dosage; Antifungal Agents - adverse effects; Antifungal Agents - therapeutic use; Biological and medical sciences; bone-marrow transplantation; Cohort Studies; Drug Administration Schedule; Female; fever of unknown origin; Hematologic Diseases - complications; Hematologic Diseases - drug therapy; Humans; Infusions, Intravenous; Kidney - drug effects; Male; Medical sciences; Middle Aged; Mycoses - prevention & control; nephrotoxicity; neutropenia; Pharmacology. Drug treatments; Retrospective Studies; Time Factors; Continuous process; Human; Antiprotozoal agent; High risk; Antibiotic; Antifungal agent; Amphotericin B; Polyenic compound; Perfusion; Parasiticide; Comparative study
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkh403

Objectives: To assess whether a continuous infusion of amphotericin B (CI-AmB) is less nephrotoxic than a 4 h infusion in haematology patients with fever and neutropenia, including bone-marrow transplant recipients. Efficacy was assessed as a secondary end-point. Patients and methods: We conducted a retrospective cohort study over a 2 year period. A total of 1073 haematology admissions were reviewed (98.3% complete) and 81 admissions were eligible for study entry; 39 received CI-AmB and 42 a 4 h infusion of AmB. Results: Renal impairment occurred significantly less frequently with CI-AmB compared with a 4 h infusion of AmB [10% versus 45%, respectively, odds ratio (OR) 0.14; 95% confidence interval (CI) 0.04–0.5, P<0.001]. The difference was maintained among allogeneic transplant recipients (P=0.007) and patients receiving concurrent nephrotoxic drugs (P<0.001). An AmB infusion rate of <0.08 mg/kg/h was associated with a significant reduction in renal impairment (P<0.001). A difference in survival was observed between the continuous and 4 h infusion of AmB (95% versus 79%, respectively, OR 5.1; 95% CI 1.02–25.1, P=0.03). Conclusions: CI-AmB appears to be significantly less nephrotoxic than 4 h infusion AmB in haematology patients with fever and neutropenia—including high-risk bone-marrow transplant recipients—without increasing mortality. An AmB infusion rate of <0.08 mg/kg/h appears to be a safe threshold, associated with reduced renal impairment.