To the Editor.—
We wish to comment on the recent report by Rosch et al (235:1995, 1976) that suggests a protective effect of mannitol when used in conjunction with the nephrotoxic antifungal agent amphotericin B. Although the single case report suggests a role for mannitol, it nevertheless remains anecdotal. The hazard of extending this type of information to clinical practice must be emphasized.Although a report1 from this institution likewise suggested a beneficial effect of mannitol in recipients of amphotericin B, a controlled study that we are currently concluding indicates no protective role. An identical conclusion was reached by Bullock et al.2 These investigators found no differences in the degree of renal impairment between groups of patients receiving amphotericin alone, and amphotericin plus mannitol.We therefore urge that purported beneficial results of therapy be subjected to controlled trial before acceptance by the medical community.
Williams TW, Olivero JJ, Westerman EL, Smilack JD. Mannitol and Amphotericin B. JAMA. 1976;236(10):1118. doi:10.1001/jama.1976.03270110020017
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