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Administration of amphotericin B in lipid emulsion decreases nephrotoxicityResults of a...
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Administration of amphotericin B in lipid emulsion decreases nephrotoxicityResults of a prospective, randomized, controlled study in critically ill patients
作者:
Patrick MD Sorkine,
Hagit MD Nagar,
Avi MD Weinbroum,
Arick MD Setton,
Evjeni MD Israitel,
Alexander MD Scarlatt,
Aviel MD Silbiger,
Valery MD Rudick,
Yoram MD Kluger,
Pinchas MD Halpern,
期刊:
Critical Care Medicine
(OVID Available online 1996)
卷期:
Volume 24,
issue 8
页码: 1311-1315
ISSN:0090-3493
年代: 1996
出版商: OVID
数据来源: OVID
摘要:
ObjectivesTo evaluate the differences in efficacy and in clinical and biochemical tolerance to amphotericin B administered in a lipid emulsion compared with amphotericin B administered in 5% dextrose in water in the treatment of Candida albicans infection in intensive care unit (ICU) patients.DesignProspective, controlled, randomized study, conducted during a 2.5-yr period, comparing the two treatment protocols.SettingGeneral ICU of a university-affiliated municipal hospital.PatientsSixty consecutive critically ill patients with confirmed or suspected Candida infection.InterventionsPatients received amphotericin B (1 mg/kg/24 hrs), administered randomly in 5% dextrose in water (group A), or in lipid emulsion (20% Intralipid Registered Trademark) (group B).Measurements and Main ResultsClinical tolerance (fever, chills, hemodynamics), hepatorenal tolerance, and biological tolerance (serum electrolytes and coagulation profile) were evaluated. Patients receiving amphotericin B in lipid emulsion experienced a lower frequency rate of drug-associated fever (61.4% vs. 5.8%, p < .003) rigors (54% vs. 8.5%, p < .004), hypotension (17% vs. 0%), and nephrotoxicity (increase of serum creatinine concentration, 66.7% vs. 20%, p < .0002). Significant (264,500 +/- 71,460 to 163,570 +/- 34,450 mm3, p < .01) thrombocytopenia, not associated with active bleeding, occurred in patients receiving amphotericin B lipid in emulsion but not in patients receiving the drug in dextrose.ConclusionsTreatment with amphotericin B in a lipid emulsion when given to critically ill patients with Candida sepsis seems to be safer and as effective as the conventional mode of administration.(Crit Care Med 1996; 24:1311-1315)
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