Prophylactic intravenous amphotericin B in neutropenic autologous bone marrow transplant recipients.
This study assessed the efficacy, toxicity, and pharmacology of low-dose amphotericin B given prophylactically to patients (serum concentrations of 0.2-0.4 microgram/ml) undergoing bone marrow transplantation. Yeast isolates from patients' oropharyngeal areas had MICs of 0.1-0.2 microgram/ml, and none were amphotericin B resistant. The effect of low-dose amphotericin B on reducing the numbers of yeast colonizing the oropharyngeal area was significant (P less than .01). The average delay in switching to high-dose prophylactic amphotericin B was only 1 day; the decision to do so because of a perceived fungal infection occurred more frequently for the placebo group (P = .06). Fewer patients from the low-dose amphotericin B group (8.8%) than from the placebo group (14.3%) had fungi isolated from normally sterile body sites (P = .35). Infusion-related side effects but not systemic toxicities were significantly greater (P less than .001) in the amphotericin B group. The 6-week survival was greater in those receiving amphotericin B (P less than .03), but the improved survival could not be attributed to the prevention of fungal infections.
Perfect
J R
JR
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
Klotman
M E
ME
Gilbert
C C
CC
Crawford
D D
DD
Rosner
G L
GL
Wright
K A
KA
Peters
W P
WP
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002180:Candidiasis, Oral / Q000517:prevention & control; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009181:Mycoses / Q000517:prevention & control*; D009503:Neutropenia / Q000150:complications* / Q000188:drug therapy; D009960:Oropharynx / Q000382:microbiology
D000666:Amphotericin B