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Article
November 1988

Prevention of Amphotericin B—Induced Renal Impairment: A Review on the Use of Sodium Supplementation

Author Affiliations

From the Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn.

Arch Intern Med. 1988;148(11):2389-2394. doi:10.1001/archinte.1988.00380110049010
Abstract

• Amphotericin B is the treatment of choice for most deepseated mycoses; however, doses may have to be limited because of concern over adverse effects such as nephrotoxicity. Evolving evidence suggests that the extent of amphotericin B—induced renal impairment may be modified via alteration of a normal physiologic feedback response that further contributes to changes due to direct nephrotoxicity. As such, renal impairment has a substantial theoretically preventable and reversible element. In animals exposed to amphotericin B, sodium loading interferes with this response. Mounting clinical evidence also supports the usefulness of sodium supplementation to prevent as well as to reverse amphotericin B—induced nephrotoxicity. At this time, the use of sodium supplementation (eg, intravenous saline and/or ticarcillin disodium, which contains 5.2 mEq of sodium per gram of drug) along with avoiding dehydration appears to be a safe and effective means of reducing the risk of nephrotoxicity associated with amphotericin B administration; however, it is not known whether renal changes can be entirely prevented. These preliminary observations merit confirmation in a prospective, randomized clinical trial.

(Arch Intern Med 1988;148:2389-2394)

The incidence of mycotic disease is increasing. A recent survey indicates that fungal organisms are isolated in from 1% to 12% of hospitalized patients, currently accounting for approximately 5% of all cases of primary septicemia.1 The reason for this escalation in mycotic disease is the increased number of patients occupying hospital beds with risk factors for fungal infections. The major risk factor is impaired host defense mechanisms due to underlying disease (eg, acquired immunodeficiency syndrome) or therapeutic maneuvers (eg, cancer chemotherapy, radiotherapy, iatrogenic immunosuppression for organ transplantation).

Despite the availability of newer antifungal agents, amphotericin B (Fungizone) remains the broad-spectrum antifungal antibiotic of choice for the treatment of deepseated mycotic infections. Unfortunately, this drug causes a variety of adverse effects, including fever, chills, nausea,

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