Efficacy of amphotericin B in a fat emulsion for the treatment of cryptococcal meningitis in AIDS patients.
Several formulae have been developed in an attempt to reduce the toxicity of amphotericin B (AmB), but their high costs preclude widespread use. The aim of this study was to evaluate the efficacy of amphotericin B in a fat emulsion, i.e. Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). We retrospectively reviewed data collected in a non-comparative open study between January 1999 and December 2001. The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms or complete absence or improvement of the mycological alterations of the CSF. The outcomes were evaluated at 2 weeks, induction phase (IP), and at the end of treatment or consolidation phase (CP) with the last available CSF. Prior to the diagnosis of CM, 72% of patients had had one or more OI and 67.57% had a concomitant OI. The median CD4-cell count was 32 cells/mm(3), the median leukocyte count in the CSF was 29 cells/mm(3) and the median cumulative dose of AmB-IL was 1,200 mg (300-2,500). The therapeutic cure was 57.14% in the IP and 64.86% in the CP. During IP, 9 patients died (24.32%) and 4 (10.81%) during the CP (p=0.2). Thus, the overall mortality rate was 35.14%. AmB-IL, an inexpensive preparation, might be an alternative to conventional AmB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs other than AmB are available to treat systemic fungal infections.
Rubio
Fernando Góngora
FG
Infectious, Parasitary and Dermatologic Diseases Department, São José do Rio Preto Medical School, Rua Sebastião Bernardino de Souza 100, Brejo Alegre, 15062-001 São José do Rio Preto, SP, Brazil. gongora@famerp.br
Zanon
Jeferson Rodrigo
JR
de Almeida
Margarete Teresa Gottardo
MT
de Góngora
Delzi Vinha Nunes
DV
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents; D005217:Fat Emulsions, Intravenous; D000666:Amphotericin B