Efficacy of Intralipid infusion in reducing amphotericin-B-associated nephrotoxicity in head and neck invasive fungal infection: A randomized, controlled trial.

Abstract

Amphotericin B deoxycholate (ABD) is the best therapeutic agent available for the treatment of most systemic fungal infections. However, some untoward adverse effects such as nephrotoxicity may limit its appropriate therapeutic use. We conducted a randomized, controlled trial ofthe infusion of fat emulsion (Intralipid) shortly after the infusion of ABD to evaluate its effects on reducing ABD-associated nephrotoxicity. Our patient population was made up of 31 patients who were randomized into two groups: an intervention group (n = 16) and a control group (15 patients). There were no statistically significant differences between the two groups in demographic or clinical variables. All patients received 1mg/kg/day of ABD in dextrose 5%. In addition, the patients in the intervention arm received Intralipid 10%, which was started as soon as possible within 1 hour after the infusion of ABD. ABD-associated nephrotoxicity was defined as a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl. We also measured daily serum creatinine changes during the first 2 weeks of treatment, and we compared some other relevant indices of renal function, as well as ABD-related hypokalemia. We found no statistically significant differences between the two treatments in terms of ABD-associated nephrotoxicity or any of the other indices. We conclude that the administration of Intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity or hypokalemia.

• Authors: Mehrdad Hasibi, Sirous Jafari, Seyyed Ali Manshadi, Marjan Asadollahi, Mohammadreza Salehi, Varasteh Vakili Zarch, Ali Kouhi
• Journal: Ear, nose, & throat journal (Ear Nose Throat J) Vol. 96 Issue 2 Pg. E18-E22 (Feb 2017) ISSN: 1942-7522 [Electronic] United States
• PMID: 28231371 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Antifungal Agents
• Drug Combinations
• Fat Emulsions, Intravenous
• Deoxycholic Acid
• Amphotericin B
• amphotericin B, deoxycholate drug combination
• Creatinine

Topics

• Adult
• Aged
• Amphotericin B (administration & dosage, adverse effects)
• Antifungal Agents (administration & dosage, adverse effects)
• Creatinine (blood)
• Deoxycholic Acid (administration & dosage, adverse effects)
• Drug Combinations
• Fat Emulsions, Intravenous (administration & dosage)
• Female
• Head (microbiology)
• Humans
• Hypokalemia (chemically induced)
• Invasive Fungal Infections (drug therapy)
• Kidney (drug effects, physiopathology)
• Kidney Diseases (chemically induced, prevention & control)
• Kidney Function Tests
• Male
• Middle Aged
• Neck (microbiology)
• Treatment Outcome
• Young Adult