Maserati R, Viale P, Rivolta GE, Villam P, Alberici F, Regazzi MB; International Conference on AIDS.
Int Conf AIDS. 1993 Jun 6-11; 9: 362 (abstract no. PO-B09-1362).
Infectious Disease Dept., IRCCS San Matteo, Pavia, Italy.
In a prospective, open study we treated 8 AIDS pts with oropharyngeal candidiasis (7) and CNS cryptococcosis (1) with a mixture of amphotericin B (Am-B) and a lipid solution usually employed for parenteral nutrition (Intralipid R). Am-B daily dose (0.42 to 0.8 mg/kg-mean 0.5-) was diluted in 100 ml of lipid solution and infused over 1 hr. Pts (6M, 2F, 26 to 54 yrs-old; 4 to 128 CD4/microL, mean 62) were treated for a mean of 10 1 days (3 to 29). In 1 case we had to stop the treatment at day 4 because of fever and malaise, subsequently related to disseminated CMV disease and not to this specific therapy. Apart from this pt., we did not observe any side-effect such as chills, malaise, or other commonly Am-B-related draw-backs namely in no cases renal toxicity develop. Candida lesions resolved in all pts. and fungal culture became negative in cryptococcosis case. We also performed kinetic studies on samples stored at -20 C and run on HPLC. After the first dose of Am-B, a mean Cmax of 1.24 mg/L (0.42 to 2.93) was found. Cmin at 24 hrs ranged from 0.13 to 0.65 mg/L. Trough levels after the second infusion were roughly twice the initial value and remained constant thereafter accumulation index at steady state was 2.1 +/- 0.5. The single CSF level we measured in the pt with cryptococcosis turned out to be 0.06 mg/L. In this preliminary evaluation we found that: 1) the mixture of Am-B plus lipid emulsion is exceptionally well tolerated if compared to Am-B alone; 2) clinical efficacy resulted comparable; 3) kinetic data, even if quite dispersed because of different dosages and, probably, different concomitant medications, indicate therapeutic levels and relatively low accumulation index. This novel approach in infusing Am-B may be worth further investigations.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Amphotericin B
- Candida
- Candidiasis
- Cryptococcosis
- Drug Therapy, Combination
- Fat Emulsions, Intravenous
- Lipids
- Mycoses
- Prospective Studies
- drug therapy
- therapy
Other ID:
UI: 102204280
From Meeting Abstracts