Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 11 , ISSUE 3 ( July, 2007 ) > List of Articles

ORIGINAL ARTICLE

Amphotericin B for cryptococcal meningitis in HIV positive patients: Low dose versus high dose

S. Rajeshwari, Prabha M.R. Adhikari*, John T. Ramapuram*, Satish Rao*, M.R.S.M. Pai, Kiran*

Keywords : Amphotericin B, cryptococal meningitis, human immunodeficiency virus, hypokalemia

Citation Information : Rajeshwari S, Adhikari* PM, Ramapuram* JT, Rao* S, Pai M, K. Amphotericin B for cryptococcal meningitis in HIV positive patients: Low dose versus high dose. Indian J Crit Care Med 2007; 11 (3):112-116.

DOI: 10.4103/0972-5229.35083

License: CC BY-ND 3.0

Published Online: 01-04-2011

Copyright Statement:  Copyright © 2007; The Author(s).


Abstract

Aim: To compare the safety and efficacy of low dose vs high dose of amphotericin B in cryptococcal meningitis associated with HIV infection. Materials and Methods: Retrospective data of patients admitted with clinical diagnosis with or without microbiological evidence of cryptococcal meningitis was collected from Jan 2000-Mar 2006. Patients′ details were collected in a proforma which included patient′s age, weight, signs and symptoms of disease and microbiological report (blood and CSF analysis). Data also included coexisting disease; concomitant medications taken along with amphotericin B. Adverse drug reactions which occurred during the period of treatment were recorded. Patients were grouped as low dose group and high dose group depending on the dose of amphotericin B given for the treatment of cryptococcal meningitis. Patients who received amphotericin B at doses of 0.33 to 0.64 mg/kg body weight per day were categorized under low dose group and patients who received amphotericin B at doses of 0.7 to 1.1 mg/kg/day were categorized under high dose group. All data were pooled and analyzed between the groups using chi square test. Result: Total number of patients included in the study were 38, 26 in the low dose group and 12 in the high dose group. In the low dose group, 20 were males and six were females, in the high dose group eight were males and four were females. The commonest underlying diseases were tuberculosis (17 in low dose group, nine in high dose group), Pneumocystis carinii (jeroveci) pneumonia (16 in low dose group, seven in high dose group) and oral candidiasis (eight in low dose group, seven in high dose group), Toxoplasmosis (three in low dose group, one in high dose group), hypertension (1 in group A) and diabetes mellitus (1 in group B). Concomitant medication received along with amphotericin B for coexisting diseases in both the groups were antitubercular therapy, cotrimoxazole, antiviral therapy and premedications such as Ondansetran, Domperidone, Diclofenac, Mannitol, Dexamethazone and Pheniramine. Comparison between the groups showed that the cure rate is similar in both the groups (P =0.440, where as over all mortality was higher in low dose group than in high dose group which was statistically significant (P =0.03). Adverse effects were higher in high dose group than in low dose group such as hypokalemia (P =0.04), facial puffiness (P =0.01). Other adverse effects were comparable in both the groups. Conclusion: High dose of amphotericin B therapy is more efficacious. However hypokalemia and clinical features of nephrotoxicity was higher with patients on high dose therapy, which can be managed by proper monitoring.


PDF Share
  1. Increasing invitro resistance in Cryptococcus neoformans Cambodian isolates: April 2000-to 2002. J Antimicrob Chemother 2004;54:563-5.
  2. Liposomal amphotericin B compared with amphotereicin B both followed by oral fluconazole in the treatment of AIDS-associated cryptococcal meningitis. AIDS 1997;11:1463-71.
  3. “Fungal infections in AIDS patients”. Grand Rounds Infect Dis 1994;4:5-11.
  4. Cryptococcosis: Population-based multi-state active surveillance and risk factors in human immunodeficiency virus infected persons. Cryptococcal Active Surveillance Group. J Infect Dis 1999;179:449-54.
  5. Cryptococcosis in the immunocompromized host with special reference to AIDS. Indian J Chest Dis Allied Sci 2000;42:311-5.
  6. Clinical profile of HIV in India. Indian J Med Res 2005;121:377-94.
  7. Cryptococcosis. In. Medical mycology. The pathogenic Fungi and the Pathogenic Actinomycetes. 3 rd ed. Saunders: Philadelphia; 1998. p. 582-609.
  8. Comparison of effects of amphotericin B deoxycholate infused over 4 to 24 hrs: Randomized controlled trial. BMJ 2001;322:579-82.
  9. A prospective study of AIDS- associated cryptococcal meningitis in Thailand treatment with high dose amphotericin B. J Infect 2001;43:226-33.
  10. der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, et al. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. N Engl J Med 1997;337:15-21.
  11. Comparision of amphotericin B with fluconazole in the treatment of acute ADIS-associated cryptococcal meningitis. N Engl J Med 1992;326:83-9.
  12. Invasive fungal infections in children: Recent advances in diagnosis and treatment. Adv Pediatr Infect Dis 1996;11:187-290.
  13. Amphotericin B therapy: Past, present and future. Infect Dis Clin Pract 1993;2:81-93.
  14. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730-51.
  15. Liposomal and lipid formulations of amphotericin B: Clinical pharmacokinetics. Clin Pharmacokinet 1992;23:279-91.
  16. Lipid formulations of amphotericin B: Does the emperor need new cloths? Ann Intern Med 1996;124:921-3.
  17. The use of lipid formulations of amphotericin B for systemic fungal infections. Leukemia 1996;10:1570-5.
  18. Efficacy and adverse effects of higher dose amphotericin B monotherapy for cryptococcal meningitis in patients with advanced HIV infection. J Microbiol Immunol Infect 1998;31:233-9.
  19. Cryptococosis. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Principles of internal medicine. 16 th ed. McGraw Hill: 2005. p. 1183-5.
  20. Estimation of the prevalence of cryptococcal infection among patients infected with the human immunodeficiency virus in New York city. Clin Infect Dis 1994;19:1029-33.
  21. Declining morbidity and mortality among patients with advanced HIV infection. N Engl J Med 1998;338:853-60.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.