Experience with community-based amphotericin B infusion therapy.
OBJECTIVE
To identify the types and frequencies of adverse events associated with community-based amphotericin B infusion therapy. A second objective was to validate the effectiveness of a monitoring system, based on guidelines from the Infectious Diseases Society of America (IDSA).


METHODS
Retrospective medical record review.


METHODS
Outpatient clinic at a tertiary care center.


METHODS
One hundred five patients who received amphotericin B therapy from a home care provider between January 1997 and July 2002.


RESULTS
A total of 113 courses of amphotericin B formulations were administered: liposomal amphotericin B, 41 courses (36%), amphotericin B deoxycholate, 31 courses (27%), amphotericin B lipid complex, 31 courses (27%), and amphotericin B colloidal dispersion, 3 courses (3%); an additional 7 courses consisted of sequential therapy with two different formulations. Nephrotoxicity was associated with 46 (41%) courses, electrolyte abnormalities with 40 (35%) courses, venous access device complications with 12 (11%) courses, and infusion reactions with 13 (12%) courses. Nephrotoxicity occurred most frequently in adults aged 60 years or older, solid organ transplant recipients, and those receiving concomitant cyclosporine. Only two (12%) of 17 courses in children younger than 13 years were associated with nephrotoxicity. Thirteen of all 113 courses resulted in patients requiring hospital admission due to their adverse events. Monitoring of electrolyte, serum creatinine, and blood urea nitrogen levels 2 or 3 times/week was adequate for identifying these events.


CONCLUSIONS
Significant rates of adverse events occurred in patients who received community-based amphotericin B infusion therapy. A monitoring system based on IDSA guidelines was effective in facilitating the detection and management of these adverse events.
Malani
Preeti N
PN
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, 48109, USA.
Depestel
Daryl D
DD
Riddell
James
J
Bickley
Susan
S
Klein
Lisa R
LR
Kauffman
Carol A
CA
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004337:Drug Carriers; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000935:Antifungal Agents; D004337:Drug Carriers; D000666:Amphotericin B