amphotericin-b and Vomiting

The incidence of invasive fungal infections has increased globally as a result of several factors. Conventional amphotericin B (sodium deoxycholate) has been used as standard therapy for the treatment of invasive fungal infections; however, it is associated with adverse drug reactions, including acute kidney injury (AKI). New formulations of amphotericin B have aimed to improve the safety profile of the conventional formulation.. This review aimed to assess the effects of amphotericin B deoxycholate versus liposomal amphotericin B on kidney function.. We searched Cochrane Kidney and Transplant's Specialised Register to 10 March 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.. We included randomised controlled trials (RCTs) that compared amphotericin B sodium deoxycholate with liposomal amphotericin B.. Two authors independently assessed studies for eligibility and conducted risk of bias evaluation.. We included 12 studies (2298 participants) in this review. Of these, 10 were meta-analysed (2172 participants). Liposomal amphotericin B was found to be significantly safer than conventional amphotericin B in terms of serum creatinine increase (RR 0.49, 95% CI 0.40 to 0.59). There was significant decrease in all infusion-related reactions in the liposomal group compared with the conventional group: fever (4 studies, 1092 participants): RR 0.39, 95% CI 0.28 to 0.55; I(2) = 32%); chills and/or rigours (5 studies, 1081 participants): RR 0.27, 95% CI 0.15 to 0.48; I(2) = 75%); fever and/or rigours (2 studies, 720 participants): RR 0.68, 95% CI 0.52 to 0.90; I(2) = 58%); nausea (6 studies, 1187 participants): RR 0.50, 95% CI 0.35 to 0.72; I(2) = 0%); and vomiting (3 studies, 1019 participants): RR 0.51, 95% CI 0.27 to 0.95; I(2) = 61%). Overall, risk of bias in included studies was low or unclear for most domains. However, blinding of participants and personnel, blinding of outcome assessment and other bias (funding) tended to have a high risk of bias. The sensitivity analysis performed did not change the significance of difference in favour of the liposomal formulation. Assessment for publication bias found that review results were robust.. Current evidence suggests that liposomal amphotericin B is less nephrotoxic than conventional amphotericin B (when the effect on kidney function is measured as an increase in serum creatinine level equal to or greater than two-fold from the baseline level). We also found that there were fewer infusion-related reactions associated with the liposomal formulation.

Topics: Adult; Amphotericin B; Antifungal Agents; Child; Chills; Creatinine; Deoxycholic Acid; Drug Combinations; Female; Fever; Humans; Kidney; Male; Nausea; Randomized Controlled Trials as Topic; Vomiting

Topics: Amphotericin B; Antifungal Agents; Chills; Fever; Fluconazole; Humans; Itraconazole; Meta-Analysis as Topic; Mycoses; Nausea; Vomiting; Water-Electrolyte Imbalance

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Chromoblastomycosis; Coccidioidomycosis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Lung Diseases, Fungal; Miconazole; Mycoses; Nausea; Piperazines; Vomiting

Topics: Amphotericin B; Antifungal Agents; Child; Child, Preschool; Creatinine; Female; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Neutropenia; Treatment Outcome; Vomiting

In this double-blind study to compare safety of 2 lipid formulations of amphotericin B, neutropenic patients with unresolved fever after 3 days of antibacterial therapy were randomized (1:1:1) to receive amphotericin B lipid complex (ABLC) at a dose of 5 mg/kg/d (n=78), liposomal amphotericin B (L Amph) at a dose of 3 mg/kg/d (n=85), or L Amph at a dose of 5 mg/kg/d (n=81). L Amph (3 mg/kg/d and 5 mg/kg/d) had lower rates of fever (23.5% and 19.8% vs. 57.7% on day 1; P<.001), chills/rigors (18.8% and 23.5% vs. 79.5% on day 1; P<.001), nephrotoxicity (14.1% and 14.8% vs. 42.3%; P<.01), and toxicity-related discontinuations of therapy (12.9% and 12.3% vs. 32.1%; P=.004). After day 1, infusional reactions were less frequent with ABLC, but chills/rigors were still higher (21.0% and 24.3% vs. 50.7%; P<.001). Therapeutic success was similar in all 3 groups.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Chills; Double-Blind Method; Drug Carriers; Female; Fever; Humans; Infusions, Intravenous; Liposomes; Male; Middle Aged; Mycoses; Nausea; Neutropenia; Survival Rate; Vomiting

Topics: Adult; Aged; Amphotericin B; Double-Blind Method; Drug Administration Schedule; Fever; Humans; Immune Tolerance; Infusions, Intravenous; Leukemia; Middle Aged; Mycoses; Nausea; Prospective Studies; Vomiting

A prospective, randomized, double-blind crossover study was performed to compare the incidence and severity of amphotericin-B-induced acute toxicity (chills, fever, nausea and vomiting) after two- and four-hour infusions in 33 leukemic patients with suspected or microbiologically proven systemic fungal infections. Each patient was treated in an alternating fashion of two- and four-hour infusions every other day. Toxicity was graded according to modified WHO-criteria. Evaluation of 264 infusions revealed no difference between the two schedules neither in incidence nor severity of acute toxic reactions. These data indicate that amphotericin B given over 2 hours is equally well--or poorly (!)--tolerated than the four-hour regimen.

Topics: Adult; Aged; Amphotericin B; Double-Blind Method; Fever; Humans; Infusions, Intravenous; Leukemia; Middle Aged; Mycoses; Nausea; Prospective Studies; Shivering; Time Factors; Vomiting

Topics: Adrenal Glands; Amphotericin B; Asthenia; Diarrhea; Fludrocortisone; Humans; Hydrocortisone; Itraconazole; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Tomography, X-Ray Computed; Vomiting

Mucormycosis is a rare fungal infection often seen in immunocompromised hosts. Isolated renal mucormycosis may however present in immunocompetent children as renal failure and has a uniformly poor prognosis if not detected and treated early into the course of illness. We present a 3-year-old boy with unrelenting pyelonephritis in whom serial urine cultures done were negative. A final diagnosis of isolated renal mucormycosis was made by magnetic resonance imaging and renal biopsy.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Child, Preschool; Dialysis; Fever; Humans; Kidney; Kidney Failure, Chronic; Magnetic Resonance Imaging; Male; Mucorales; Mucormycosis; Pyelonephritis; Treatment Outcome; Triazoles; Urinary Tract Infections; Vomiting

Blastomycosis is caused by a fungus endemic to states and providences bordering the Lawrence Rivers and the Great Lakes. It can lead to significant pathology in both immunocompetent and immunocompromised hosts. This case report describes disseminated blastomycosis in an otherwise healthy 16-year-old patient.. A 16-year-old male presented with a chief complaint of flank pain. In the Emergency Department he described additional symptoms of emesis, cough, and weight loss. His vitals were appropriate; however, he had absent lung sounds in the left lower lung field, splenomegaly, a left thigh abscess, and lower-extremity edema. Imaging studies showed a left pleural effusion, mediastinal shift to the right, splenomegaly, a left psoas abscess, and undifferentiated bony involvement of L1 transverse process and the left 12th rib. Abscess cultures grew Blastomyces dermatitides. He was treated with amphotericin B, demonstrated clinical improvement, and was discharged on itraconazole. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case fatality rate of blastomycosis is estimated at between 4.3% and 6.4%. Patients with solid organ transplant and associated immune suppression had a mortality of 33-38%. Given the nonspecific nature of this condition, a high level of suspicion is required for diagnosis, and early diagnosis is essential, as end organ damage in disseminated disease can include high-severity illness, including acute respiratory distress syndrome and central nervous system dysfunction. If any patient presents with symptomatology involving both skin and pulmonary systems, blastomycosis must be entertained as a possible diagnosis. Prompt diagnosis and treatment will significantly improve morbidity and mortality.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Emergency Service, Hospital; Flank Pain; Humans; Immunocompromised Host; Itraconazole; Male; Pleural Effusion; Radiography, Thoracic; Splenomegaly; Vomiting; Wisconsin

Fungal rhinosinusitis is being recognized and reported with increasing frequency over the last two decades worldwide. Intracranial extension is the most dreaded complication of fungal sinusitis with high mortality rates. We report a case of chronic rhinosinusitis in a 55-year-old diabetic male, caused by Fusarium species. The patient was diagnosed as a case of chronic left maxillary sinusitis with cavernous sinus thrombosis. The sinus lavage showed fungal elements on direct microscopic examination and culture revealed growth of Fusarium species within 4 days of incubation. Conservative therapy with IV amphotericin B resulted in favorable outcome of the patient. This is an extremely rare case where cavernous sinus thrombosis occurred as a complication secondary to Fusarium species rhinosinusitis.

Topics: Amphotericin B; Cavernous Sinus Thrombosis; Cefotaxime; Chronic Disease; Diabetes Mellitus, Type 2; Diplopia; Disease Susceptibility; Fusariosis; Fusarium; Headache; Humans; Insulin; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Photophobia; Rhinitis; Vomiting

Invasive fungal infections (IFIs) in patients undergoing lung transplantation (LT) are associated with significant mortality. Previous studies have shown the efficacy of aerosolized amphotericin B deoxycholate and oral fluconazole for antifungal prophylaxis. Evolving data show a potential advantage of prophylaxis with lipid-based formulations of amphotericin B in the prevention of IFIs. We reviewed the incidence of IFIs among patients receiving aerosolized amphotericin B lipid complex (ABLC) in LT.. We undertook a retrospective review of the results of our antifungal protocol in a cohort of 60 LT patients. We analyzed the efficiency, safety, and tolerability of 50 mg of aerosolized ABLC administered postoperatively for IFI prophylaxis once every 2 days for 2 weeks and then once per week for at least 13 weeks. In addition, these transplanted patients received fluconazole (200 mg/d) during the first 21 days posttransplant. The prophylaxis-related efficiency and safety were quantified for IFIs and adverse events (AEs) for 6 months after study drug initiation.. Prophylaxis was efficient in 59 (98.3%) patients. Only one patient developed a possible IFI, due to Aspergillus fumigatus. Four patients presented nausea and vomiting as an AE, although aerosolized amphotericin B was ongoing.. Nebulized ABLC was effective, safe, and well tolerated for the prophylaxis of aspergillosis in lung transplant patients during the early posttransplant period.

Topics: Administration, Inhalation; Administration, Oral; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Child; Female; Fluconazole; Humans; Lung Transplantation; Male; Middle Aged; Mycoses; Nausea; Retrospective Studies; Risk Factors; Safety; Vomiting; Young Adult

There are few reports on cryptococcal meningitis in non-HIV-infected patients in subtropical areas. We reviewed 94 non-HIV-infected patients microbiologically diagnosed with cryptococcal meningitis and hospitalized at National Taiwan University Hospital, 1977-1996. Forty-two patients (44.7%) had underlying diseases. The main initial manifestations were headache (86.2%), vomiting (72.3%) and fever (69. 1%). The 30 patients with T-cell suppression had more acute illnesses (median duration of symptoms: 14 days vs. 29 days), less typical presentations of meningitis, and reduced inflammatory responses compared with the 64 without T cell suppression. There was no statistical difference between patients who received amphotericin B treatment for 10 weeks and those received amphotericin B with subsequent fluconazole treatment, in terms of mortality rate and recurrence rate. Seventy-five patients (79.8%) had satisfactory clinical responses, and two relapsed. Eighteen patients died (19.1%) and 10 of these died within 2 weeks of hospitalization. Patients in this series had outcomes comparable with those from temperate and even tropical countries with high percentages of immunocompetent hosts. Factors significantly associated with death were lymphoma, semicoma, leukocytosis, and initial high titres of cryptococcal antigen in cerebral spinal fluid (especially >/=1 : 512). On multivariate analysis, lymphoma and initial high cryptococcal antigen titres were independent predictors of mortality.

Topics: Adolescent; Adult; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Female; Fever; Fluconazole; Headache; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Recurrence; Survival Rate; T-Lymphocytes; Taiwan; Vomiting

Topics: Amphotericin B; Antiprotozoal Agents; Back Pain; Fever; Humans; India; Leishmaniasis, Visceral; Treatment Outcome; Vomiting

Fungal cells were observed infiltrating the submucosal margins of an acutely perforated gastric ulceration in an apparently immunocompetent 3-year-old girl. Perforation had occurred 24 h after hospital admission because of pain and vomiting. Colonies of Candida tropicalis were grown from peritoneal fluid and blood cultures. After surgical repair and a 30-day treatment with amphotericin B at a daily dose of 1 mg kg-1 body weight, the child was discharged in good health. No further infections have occurred in the 3 years since treatment.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Child, Preschool; Emergency Service, Hospital; Female; Humans; Immunocompetence; Male; Pain; Rupture, Spontaneous; Stomach Rupture; Stomach Ulcer; Vomiting

Our institution used an experimental protocol for the use of inhaled amphotericin B as a prophylactic measure to prevent fungal disease in severely immunocompromised patients. We did a prospective study of the physiologic effects of amphotericin B administration. We looked specifically at oxygen saturation levels, peak flow values, and symptoms of patients given amphotericin B. We collected data on a series of 18 patients and of 132 amphotericin B administrations. Four (22%) of the patients stopped treatments because of nausea and vomiting which were believed to be due to the inhaled amphotericin B. For the remaining patients, no treatment was stopped because of symptoms or physiologic changes caused by amphotericin B, although there were 9 instances of clinically significant bronchospasm as defined by a drop in peak flow of 20% or more, 9 clinically relevant increases in cough, and 3 clinically relevant increases in dyspnea. Forty-eight percent of the clinically relevant changes occurred in patient 8. Another 16% occurred in asthmatic subjects who were significantly more likely (p = 0.03) to experience a 20% or more drop in peak flow than were patients without asthma. The physiologic profile of the response to inhaled amphotericin B is acceptable.

Topics: Administration, Inhalation; Adult; Aerosols; Agranulocytosis; Amphotericin B; Asthma; Bone Marrow Transplantation; Cough; Dyspnea; Humans; Immunocompromised Host; Leukemia; Lung Diseases, Fungal; Nausea; Nebulizers and Vaporizers; Oxygen; Prospective Studies; Pulmonary Ventilation; Vomiting

We reviewed the records of 32 patients with acute leukemia and proved invasive fungal infections to determine the clinical and pathologic characteristics of systemic mycosis in patients undergoing intensive induction chemotherapy. The incidence of invasive fungal infections among our patients was at least 27 percent, and Candida and Aspergillus accounted for the majority of these infections. Patients with systemic candidiasis generally had prolonged severe neutropenia, fever refractory to antibiotics, and evidence of mucosal colonization by fungi. At autopsy, Candida was always widely disseminated. Patients with aspergillosis generally had neutropenia, fever, and pulmonary infiltrates at the time of admission to the hospital and, at autopsy, their infections were primarily confined to the lungs. Patients infected with both Candida and Aspergillus had clinical and pathologic findings that were a combination of the features of each type of infection. A diagnosis of invasive fungal infection was established before death in only nine of the patients, all of whom had systemic candidiasis. Four of these patients were successfully treated and survived their hospitalization. The reasons for frequently misdiagnosing and unsuccessfully treating systemic mycosis in patients with acute leukemia are examined, and suggestions are made for improved management of patients at high risk for these infections. These suggestions are based upon recognition of the clinical settings in which fungal infections occur, the aggressive use of invasive diagnostic procedures, and the early empiric use of amphotericin B.

Topics: Acute Disease; Amphotericin B; Aspergillosis; Candidiasis; Humans; Leukemia; Lung; Lung Diseases, Fungal; Nausea; Retrospective Studies; Vomiting

Topics: Administration, Oral; Adolescent; Amphotericin B; Anorexia; Blood Platelets; Blood Transfusion; Candidiasis; Drug Eruptions; Humans; Infusions, Parenteral; Injections, Intramuscular; Leucovorin; Methotrexate; Nausea; Osteosarcoma; Pneumothorax; Stomatitis; Vomiting

Topics: Amphotericin B; Blood Urea Nitrogen; Coccidioidomycosis; Fever; Histoplasmosis; Humans; Injections, Intramuscular; Injections, Intravenous; Methods; Nausea; Pain; Procaine; Sporotrichosis; Stimulation, Chemical; Vomiting

Topics: Amphotericin B; Electrocardiography; Fever; Histoplasmosis; Humans; Laryngeal Diseases; Male; Middle Aged; Nausea; Vocal Cords; Vomiting

Two patients on prolonged steroid therapy developed meningitis due to Cryptococcus neoformans. The first responded satisfactorily to treatment with amphotericin B, both initially and again following relapse. The second died shortly after treatment was begun. Pathogenicity studies suggest that the strain isolated from the fatal case was the more virulent. Cryptococcal meningitis probably occurs more often in Britain than is generally appreciated, and this possibility should be remembered when investigating patients with obscure forms of meningitis; if not, then the correct diagnosis may not be made. Attention is drawn to the increasing number of recently reported cases of this disease which have been associated with long-term steroid therapy.

Topics: Adult; Aged; Amphotericin B; Blood Cell Count; Carbohydrates; Cerebrospinal Fluid Proteins; Cryptococcosis; Female; Glucocorticoids; Humans; Male; Meningitis; Middle Aged; Nausea; Urea; Vomiting

Topics: Amphotericin B; Biomedical Research; Blastomycosis; Chlorpromazine; Coccidioidomycosis; Cryptococcosis; Drug Therapy; Fever; Histoplasmosis; Humans; Lactose; Nausea; Pentobarbital; Sporotrichosis; Toxicology; Vomiting

Topics: Amphotericin B; Anaphylaxis; Anemia; Anuria; Blushing; Feeding and Eating Disorders; Fever; Headache; Heart Failure; Humans; Hypokalemia; Kidney Diseases; Liver Diseases; Meningitis; Nausea; Pain; Paralysis; Paresthesia; Phlebitis; Seizures; Thrombocytopenia; Toxicology; Ventricular Fibrillation; Vertigo; Vomiting