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.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
3.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*
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.Retinal Toxicity of Repetitive Intravitreal Injections of Amphotericin B.
Journal of the Korean Ophthalmological Society 1991;32(7):550-556
Authors evaluated the retinal toxic reation of intravitreal injection with a regimens of 10 microgram of amphotericin B on both phakic and aphakic eyes of rabbits. In addition to the eye receiving single injection, the effects of repeating the same dose second and third time at interval of 1 week were examined by light microscopy after last injection. The results were as follows: 1. Even a single intravitreal injection with regimens of 10 microgram amphotericin B, vitreous opacities and posterior subcapsular lens opacities were observed ophthalmoscopically. 2. A single and repeated intravitreal injections with regimens of 10 microgram amphotericin B showed focal areas of retinal toxic reation. 3. Lens extraction did not modify the retinotoxic reation of intravitreally administrated amphotericin B. 4. Repetitive intravitreal injection of amphotericin B did not show increasing retinal toxic reation.
Amphotericin B*
;
Cataract
;
Intravitreal Injections*
;
Microscopy
;
Rabbits
;
Retinaldehyde*
10.Evaluation of Spectrophotometric Broth Microdilution Methods for Determining Antifungal Susceptibilities of Aspergillus Species.
Mi Ra PARK ; Jong Hee SHIN ; Jeong Won SONG ; Young Kyu PARK ; Duck CHO ; Seung Jung KEE ; Myung Geun SHIN ; Soon Pal SUH ; Dong Wook RYANG
The Korean Journal of Laboratory Medicine 2004;24(5):301-307
BACKGROUND: A spectrophotometric approach to minimum inhibitory concentration (MIC) determination for filamentous fungi may provide an objective and rapid MIC reading, and quantify the hyphal growth of molds. In this study, we evaluated two spectrophotometric broth microdilution methods (SBM) to determine amphotericin B and itraconazole MICs for Aspergillus species isolated from clinical specimens. METHODS: A total of 80 clinical isolates (20 A. fumigatus, 20 A. flavus, 18 A. niger, 20 A. terreus, and 2 A. nidulans) were tested for amphotericin B and itraconazole susceptibility by the broth microdilution method. The MIC endpoint was calculated by the spectrophotometer with microplate reader (SBM-Spec method) or colorimetric XTT (tetrazolium dye) method (SBM-XTT method). The results of the SBM method were compared with those of NCCLS M38-A broth microdilution method. RESULTS: The MICs of amphotericin B by the NCCLS M38-A method ranged from 0.125 to 8 g/mL, and those of itraconazole ranged from 0.25 to 2micrograms/mL. The agreement of SBM-Spec and SBM-XTT methods within one dilution of the NCCLS M38 reference were 98.8% and 96.3% for the ampho-tericin B, and 98.8% and 100% for itraconazole, respectively. The agreements between SBM-Spec and SBM-XTT methods were 97.5% for amphotericin B and 98.8% for itraconazole. CONCLUSIONS: In antifungal susceptibility testing of Aspergillus species, the SBM method includ-ing SBM-Spec and SBM-XTT methods showed high levels of agreements with the NCCLS M38-A method. The SBM methods can be useful in the clinical laboratory.
Amphotericin B
;
Aspergillus*
;
Fungi
;
Itraconazole
;
Microbial Sensitivity Tests
;
Niger