Caillot D, Reny G, Solary E, Casasnovas O, Chavanet P, Bonnotte B, Perello L, Dumas M, Entezam F, Guy H
Department of Clinical Haematology, Centre Hospitalier-Universitaire Le Bocage, Dijon, France.
J Antimicrob Chemother. 1994 Mar;33(3):603-13. doi: 10.1093/jac/33.3.603.
Patients with haematological malignancies requiring an antifungal therapy were randomly assigned to receive amphotericin B diluted in either 5% dextrose or in fat emulsion (Intralipid). Twenty-one patients were included in each group. Mean duration of amphotericin B therapy was 8.4 days in the dextrose group and 12.8 days in the Intralipid group. Amphotericin B infusion induced chills in 16 of 21 patients in the dextrose group and in 5 of 21 in the Intralipid group (P = 0.0008). Serum creatinine increased > 75% from baseline in ten patients in the dextrose group compared with only two in the Intralipid group (P = 0.007). A > or = 50% decrease of creatinine clearance was observed in 14 of 21 patients in the dextrose group compared with seven of 21 patients in the Intralipid group (P = 0.025). No difference was found between the two groups with regard to potassium and sodium requirement. Among patients who did not receive magnesium before antifungal therapy, magnesium supplementation was required more frequently in the dextrose group (8/12 vs 2/11; P = 0.02). Concomitant amikacin dosage reduction was more frequent in the dextrose group due to nephrotoxicity (7/19 vs 2/20; P = 0.045). A similar difference in vancomycin dosage reduction was observed between the two groups (12/20 vs 5/19; P = 0.03).
需要抗真菌治疗的血液系统恶性肿瘤患者被随机分配接受用5%葡萄糖或脂肪乳剂（英脱利匹特）稀释的两性霉素B治疗。每组纳入21例患者。两性霉素B治疗的平均持续时间在葡萄糖组为8.4天，在英脱利匹特组为12.8天。两性霉素B输注在葡萄糖组的21例患者中有16例引起寒战，在英脱利匹特组的21例中有5例引起寒战（P = 0.0008）。葡萄糖组有10例患者血清肌酐较基线水平升高>75%，而英脱利匹特组仅2例（P = 0.007）。葡萄糖组21例患者中有14例肌酐清除率下降≥50%，而英脱利匹特组21例患者中有7例（P = 0.025）。两组在钾和钠需求方面未发现差异。在抗真菌治疗前未接受镁剂的患者中，葡萄糖组更频繁地需要补充镁剂（8/12 vs 2/11；P = 0.02）。由于肾毒性，葡萄糖组更频繁地需要减少阿米卡星的剂量（7/19 vs 2/20；P = 0.045）。两组在万古霉素剂量减少方面也观察到类似差异（12/20 vs 5/19；P = 0.03）。
