Malani Preeti N, Depestel Daryl D, Riddell James, Bickley Susan, Klein Lisa R, Kauffman Carol A
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, 48109, USA.
Pharmacotherapy. 2005 May;25(5):690-7. doi: 10.1592/phco.25.5.690.63591.
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).
Retrospective medical record review.
Outpatient clinic at a tertiary care center.
One hundred five patients who received amphotericin B therapy from a home care provider between January 1997 and July 2002.
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.
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.
确定与基于社区的两性霉素B输注治疗相关的不良事件的类型和发生率。第二个目的是根据美国传染病学会（IDSA）的指南验证监测系统的有效性。
回顾性病历审查。
三级护理中心的门诊诊所。
1997年1月至2002年7月期间从家庭护理机构接受两性霉素B治疗的105名患者。
共给予113个疗程的两性霉素B制剂：脂质体两性霉素B，41个疗程（36%）；两性霉素B脱氧胆酸盐，31个疗程（27%）；两性霉素B脂质复合物，31个疗程（27%）；两性霉素B胶体分散液，3个疗程（3%）；另外7个疗程包括两种不同制剂的序贯治疗。46个疗程（41%）出现肾毒性，40个疗程（35%）出现电解质异常，12个疗程（11%）出现静脉通路装置并发症，13个疗程（12%）出现输注反应。肾毒性在60岁及以上的成年人、实体器官移植受者以及同时接受环孢素治疗的患者中最常见。13岁以下儿童的17个疗程中只有2个（12%）与肾毒性有关。所有113个疗程中有13个疗程的患者因不良事件需要住院治疗。每周监测电解质、血清肌酐和血尿素氮水平2或3次足以发现这些事件。
接受基于社区的两性霉素B输注治疗的患者中不良事件发生率较高。基于IDSA指南的监测系统有效地促进了这些不良事件的检测和管理。
