1.Risk factors for Amphotericin B Nephrotoxicity among children six months to eighteen years old admitted at the Philippine Children’s Medical Center.
Diosemil L. Leyson-Guzman ; Alona A. Briones ; Maria Rosario S. Cruz ; Ma. Norma V. Zamora ; Rachelle C. Dela Cruz
The Philippine Children’s Medical Center Journal 2019;15(1):44-52
BACKGROUND:
Amphotericin B is used in pediatrics for severe fungal infections despite its known
nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk
factors that predispose children to developing these complications still undefined.
OBJECTIVES:
To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B
treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017
METHODS:
This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at
least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not
develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models.
RESULTS:
Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and
nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity.
CONCLUSION:
Risk factors for nephrotoxicity were malignancy as an underlying medical condition,
duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal
nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing
nephrotoxicity.
RECOMMENDATIONS
Clinicians should consider these risk factors, institute measures to monitor
occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With
identification of the population at risk, prospective research on determining the specific onset of renal
effects and possible intervention is recommended.
Amphotericin B
2.A case of percutaneous intracavitary amphotericin B instillation for the treatment of hemoptysis due to pulmonary aspergilloma.
Hong Lyeol LEE ; Hong Keun CHO ; Se Kyu KIM ; Joon CHANG ; Sung Kyu KIM ; Won Young LEE ; Kyu Ok CHOE
Tuberculosis and Respiratory Diseases 1992;39(2):180-185
No abstract available.
Amphotericin B*
;
Hemoptysis*
3.E-test for Antifungal Susceptibility Testing of Candida Species.
Min KIM ; Woo Hyun LIM ; Jong Hee SHIN ; Dong Wook RYANG
Korean Journal of Clinical Pathology 1999;19(1):78-85
BACKGROUND: Although standardized broth dilution methods for antifungal susceptibility testing are available, easier testing procedures are desirable. We evaluated the E-test (AB disk, Sweden) as a possible alternative instead of NCCLS (National Committee for Clinical Laboratory Standards) broth macrodilution method. METHODS: Fifty-two bloodstream isolates of Candida spp. (including 11 C. albicans, 13 C. tropicalis, 18 C. parapsilosis, 1 C. glabrata, 4 C. krusei, 2 C. pelliculosa, 2 C. lipolytica, and 1 C. guilliermondii) were tested. Amphotericin B and fluconazole MICs for each isolate were determined by both NCCLS broth macrodilution method and E-test. The results of E-test for Candida spp. were compared with those of NCCLS macrodilution method. For selecting plating media for E-test, we compared E-test results in two different media (RPMI and Casiton medium) using five ATCC Candida strains. RESULTS: As E-test media, we selected RPMI medium for amphotericin B and Casitone medium for fluconazole because of higher agreement with NCCLS method. The E-test and NCCLS method of 52 Candida spp. yielded a very narrow range of MICs (0.064-2.0 microgram/mL) for amphotericin B and a broad range of MICs (0.5-64 microgram/mL) for fluconazole. The agreements of E-test within one doubling dilutions of the macrodilution reference were 90.4% (24h and 48h) for amphotericin B, and 90.4% (24h) and 96.2% (48h) for fluconazole. CONCLUSION: The E-test is a valuable alternative to the NCCLS macrodilution method for amphotericin B and fluconazole susceptibility testing of Candida species.
Amphotericin B
;
Candida*
;
Fluconazole
4.Primary Cutaneous Mucormycosis Associated with Trauma.
Won Keun SONG ; Hyang Joon PARK ; You Chan KIM ; Yong Woo CINN
Korean Journal of Dermatology 2000;38(6):826-827
We report a case of primary cutaneous mucormycosis, one of five clinical forms of mucormycosis, in a 68-year-old immunocompetent woman, which developed after trauma. We treated her successfully with amphotericin B for 23 days.
Aged
;
Amphotericin B
;
Female
;
Humans
;
Mucormycosis*
5.Orbital Cellularitis with Paranasal Mucormycosis.
Hwan Gyoo KIM ; Sung Kun CHUNG ; Sang Moon CHUNG
Journal of the Korean Ophthalmological Society 1990;31(6):807-811
Mucormycosis is a fungal disease in which normal saphrophytic molds produce an acute and often rapidly fatal infection. Patients with orbital mucormycosis commonly present with abrupt visual loss, orbital pain and facial hypoaethesia. In our case, mucormycosis was confirmed by histopathological examination and it was mainly treated with daily intravenous amphotericin B for 42 days. As medical treatment was successful, no orbital exenteration has been necessitated.
Amphotericin B
;
Fungi
;
Humans
;
Mucormycosis*
;
Orbit*
6.Orbital Cellularitis with Paranasal Mucormycosis.
Hwan Gyoo KIM ; Sung Kun CHUNG ; Sang Moon CHUNG
Journal of the Korean Ophthalmological Society 1990;31(6):807-811
Mucormycosis is a fungal disease in which normal saphrophytic molds produce an acute and often rapidly fatal infection. Patients with orbital mucormycosis commonly present with abrupt visual loss, orbital pain and facial hypoaethesia. In our case, mucormycosis was confirmed by histopathological examination and it was mainly treated with daily intravenous amphotericin B for 42 days. As medical treatment was successful, no orbital exenteration has been necessitated.
Amphotericin B
;
Fungi
;
Humans
;
Mucormycosis*
;
Orbit*
7.Antifungal activity of voriconazole on local isolates: An in-vitro study
Karina Q. De Sagun-Bella ; Archimedes Lee D. Agahan ; Leo DP. Cubillan ; Noel S. Carino ; Roslyn De Mesa-Rodriguez
Philippine Journal of Ophthalmology 2013;38(1):29-34
Objective:
To determine the in-vitro activity of voriconazole and compare it with amphotericin B, fluconazole,
itraconazole, ketoconazole, and caspofungin against local yeast and mold clinical isolates Candida albicans, Candida
sp., Aspergillus terreus, Aspergillus niger, and Fusarium cylindrocarpone.
Methods:
Review of the Institute of Ophthalmology microbiology records were done and was the basis for the local isolates included in the study. Mean inhibitory concentration (MIC) was determined using YeastOne Sensititre Microtitre Colorimery method (TREK Diagnostic Systems, England). Two-way ANOVA, Duncan, and Pearson chi-squared tests were used to analyze the data.
Results:
All isolates tested were sensitive to voriconazole. Eighty percent (80%) of the isolates were sensitive to amphotericin B and 25% showed resistance to itraconazole. Yeast pathogens were all sensitive to amphotericin B and voriconazole. More than 50% of the yeast pathogens were resistant to ketoconazole. Molds or filamentous fungi showed higher susceptibility to voriconazole than amphotericin B and the other antifungals.
Conclusion
Voriconazole exhibited good in-vitro activity against the isolates tested. It has the same efficacy on
yeast pathogens (Candida albicans and Candida sp.) when compared with amphotericin B. It has superior efficacy
on filamentous fungi (Aspergillus and Fusarium). There is a role for voriconazole in the treatment of ocular
infections, especially in the setting of poor antifungal drug availability.
Voriconazole
;
Amphotericin B
;
Candida
;
Fusarium
;
Aspergillus
8.New world cutaneous leishmaniasis in a traveler: The first documented case in the Philippines.
Leyritana Katerina T ; Saniel Mediadora C ; Carpo Beatriz G ; Murray Henry W
Acta Medica Philippina 2011;45(3):73-76
We describe New World cutaneous leishmaniasis (Leishmania amazonensis), a disease not endemic in the Philippines, in a 45-year-old man with ulcerating lesions on his hand and leg ater returning from South America. The patient responded to treatment with liposomal amphotericin B. This imported case of leishmaniasis highlights the importance of obtaining a detailed travel history in patients with chronic, non-healing skin lesions which should lead to earlier recognition and treatment.
Human ; Male ; Middle Aged ; Liposomal Amphotericin B ; Philippines ; Amphotericin B ; Leishmaniasis, Cutaneous ; Leishmania Mexicana ; South America
9.Comparison of Broth Macrodilution and Microdilution in Testing of Minimal Inhibitory Concentration of Candida Species.
Hyun Kyung CHOI ; Young Kee KIM ; Min Ja KIM
Korean Journal of Clinical Pathology 1997;17(4):598-608
BACKGROUND: Candida species are one ol the major pathogens causing opportunistic infection. The need for a standardized. and clinically relevant method for antifungal susceptibility testing has become more increased because resistance to antifungal agents is now being reported with increasing frequency. The purposes of this study were to measure the minimal inhibitory concentrations actions amphotericin B, flucytosine and fluconazole of clinical isolates of Candida species, and to evaluate broth microdilution method as a more efficient test method, compared with NCCLS standard broth macrodilution. METHODS: The minlmal Inhibitory concentrations of C. parapsilosis ATCC 90018, C, albicans ATCC 90028 and 32 Candida isolates from Korea University Hospital were evaluated against amphotericin B, flucytosine and fluconazole by broth macrodilution and microdilution methods. RESULTS: The minimal inhibitory concentrations of Candida species ranged 0.25 to 1.0 microgram/mL for amphotericin B, 0.125 to 2.0 microgram/mL for flucytosine and 0.125 to 64 microgram/mL for fluconazole. The percent of agreement between NCCLS standard broth macrodilution and microdilution was highest when inoculum size was 0.5-2.5x103 CFU/mL and incubation time was 48 hours, and one fold dilution agreement was 100% for amphotericin B, 100% for flucytosine and 88-96% for fluconazole. CONCLUSIONS: This study showed good agreement of results of broth microdilution test with those of macrodilution, and suggested that broth microdilution method is an accessible and useful method and can be substituted for broth macrodilutlon method with the expectation of good results.
Amphotericin B
;
Antifungal Agents
;
Candida*
;
Fluconazole
;
Flucytosine
;
Korea
;
Opportunistic Infections
10.Current Opinion in the Treatment of Opportunistic Fungal Infections.
Korean Journal of Medical Mycology 1997;2(1):9-16
Opportunistic fungal infections are significant causes of mortality and morbidity especially among the immunocompromised hosts. There is now increasing array of drugs available for their treatment. Amphotericin B is the most established and widely used antifungal agent and lipid-complexed amphotericin B preparations are introduced recently. The imidazole and triazole drugs have specific roles to play on the management of these patients. However, antifungal therapy is still limited by the lack of effective agents, lack of early diagnostic techniques to identify infection in its early stages and the developement of resistance. There are also few comparative studies of drugs within the increasing number of antifungal agents which would Provide a reliable basis for choice.
Amphotericin B
;
Antifungal Agents
;
Humans
;
Immunocompromised Host
;
Mortality