title: Efficacy of Intralipid infusion in reducing amphotericin-B-associated nephrotoxicity in head and neck invasive fungal infection: A randomized, controlled trial.
abstract: Amphotericin B deoxycholate (ABD) is the best therapeutic agent available for the treatment of most systemic fungal infections. However, some untoward adverse effects such as nephrotoxicity may limit its appropriate therapeutic use. We conducted a randomized, controlled trial ofthe infusion of fat emulsion (Intralipid) shortly after the infusion of ABD to evaluate its effects on reducing ABD-associated nephrotoxicity. Our patient population was made up of 31 patients who were randomized into two groups: an intervention group (n = 16) and a control group (15 patients). There were no statistically significant differences between the two groups in demographic or clinical variables. All patients received 1mg/kg/day of ABD in dextrose 5%. In addition, the patients in the intervention arm received Intralipid 10%, which was started as soon as possible within 1 hour after the infusion of ABD. ABD-associated nephrotoxicity was defined as a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl. We also measured daily serum creatinine changes during the first 2 weeks of treatment, and we compared some other relevant indices of renal function, as well as ABD-related hypokalemia. We found no statistically significant differences between the two treatments in terms of ABD-associated nephrotoxicity or any of the other indices. We conclude that the administration of Intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity or hypokalemia.
authors.affiliation: Department of Infectious Diseases, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Hasibi
authors.forename: Sirous
authors.initials: S
authors.lastname: Jafari
authors.forename: Seyyed Ali
authors.initials: SA
authors.lastname: Manshadi
authors.forename: Marjan
authors.initials: M
authors.lastname: Asadollahi
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Salehi
authors.forename: Varasteh Vakili
authors.initials: VV
authors.lastname: Zarch
authors.forename: Ali
authors.initials: A
authors.lastname: Kouhi
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003840:Deoxycholic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D006257:Head / Q000382:microbiology; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D000072742:Invasive Fungal Infections / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D003404:Creatinine