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Zhong X, Yang J, Liu H, Yang Z, Luo P. Potential lipid-based strategies of amphotericin B designed for oral administration in clinical application. Drug Deliv 2023; 30:2161671. [PMID: 36601799 PMCID: PMC9828648 DOI: 10.1080/10717544.2022.2161671] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Amphotericin B (AmB) is regarded as a first-line therapy against life-threatening invasive fungal infections. Due to its poor oral bioavailability, AmB is restricted to intravenous administration in clinical practice. As science continues to move forward, two lipid-based formulations are successfully developed for oral AmB administration, currently undergoing phase I clinical trials. Encouragingly, lipid-AmB conjugates with emulsions also exhibit a better bioavailability, which may be another strategy to design oral AmB formulation in clinical practice. Thus, this review mainly focused on the two lipid-based formulations in clinical trials, and discussed the potential perspectives of AmB-lipid conjugation-loaded nanocochleates and emulsions.
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Affiliation(s)
- Xiaoming Zhong
- Department of Oncology Radiotherapy, Jiangxi Cancer Hospital, Nanchang, China
| | - Jianqiong Yang
- Department of Clinical Medicine Research Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China;
| | - Hongyan Liu
- Department of Pharmacy, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Zhiwen Yang
- Department of Pharmacy, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Ping Luo
- Department of Breast surgery, Nanchang Third Hospital, Nanchang, China,CONTACT Ping Luo Department of Breast surgery, Nanchang Third Hospital, Nanchang, China
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2
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Karimzadeh I, Strader M, Kane-Gill SL, Murray PT. Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights. Curr Opin Crit Care 2023; 29:595-606. [PMID: 37861206 DOI: 10.1097/mcc.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Drug associated kidney injury (D-AKI) occurs in 19-26% of hospitalized patients and ranks as the third to fifth leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Given the high use of antimicrobials in the ICU and the emergence of new resistant organisms, the implementation of preventive measures to reduce the incidence of D-AKI has become increasingly important. RECENT FINDINGS Artificial intelligence is showcasing its capabilities in early recognition of at-risk patients for acquiring AKI. Furthermore, novel synthetic medications and formulations have demonstrated reduced nephrotoxicity compared to their traditional counterparts in animal models and/or limited clinical evaluations, offering promise in the prevention of D-AKI. Nephroprotective antioxidant agents have had limited translation from animal studies to clinical practice. The control of modifiable risk factors remains pivotal in avoiding D-AKI. SUMMARY The use of both old and new antimicrobials is increasingly important in combating the rise of resistant organisms. Advances in technology, such as artificial intelligence, and alternative formulations of traditional antimicrobials offer promise in reducing the incidence of D-AKI, while antioxidant medications may aid in minimizing nephrotoxicity. However, maintaining haemodynamic stability using isotonic fluids, drug monitoring, and reducing nephrotoxic burden combined with vigilant antimicrobial stewardship remain the core preventive measures for mitigating D-AKI while optimizing effective antimicrobial therapy.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Michael Strader
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
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3
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Karimzadeh I, Barreto EF, Kellum JA, Awdishu L, Murray PT, Ostermann M, Bihorac A, Mehta RL, Goldstein SL, Kashani KB, Kane-Gill SL. Moving toward a contemporary classification of drug-induced kidney disease. Crit Care 2023; 27:435. [PMID: 37946280 PMCID: PMC10633929 DOI: 10.1186/s13054-023-04720-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
Drug-induced kidney disease (DIKD) accounts for about one-fourth of all cases of acute kidney injury (AKI) in hospitalized patients, especially in critically ill setting. There is no standard definition or classification system of DIKD. To address this, a phenotype definition of DIKD using expert consensus was introduced in 2015. Recently, a novel framework for DIKD classification was proposed that incorporated functional change and tissue damage biomarkers. Medications were stratified into four categories, including "dysfunction without damage," "damage without dysfunction," "both dysfunction and damage," and "neither dysfunction nor damage" using this novel framework along with predominant mechanism(s) of nephrotoxicity for drugs and drug classes. Here, we briefly describe mechanisms and provide examples of drugs/drug classes related to the categories in the proposed framework. In addition, the possible movement of a patient's kidney disease between certain categories in specific conditions is considered. Finally, opportunities and barriers to adoption of this framework for DIKD classification in real clinical practice are discussed. This new classification system allows congruencies for DIKD with the proposed categorization of AKI, offering clarity as well as consistency for clinicians and researchers.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Awdishu
- Division of Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA, USA
| | | | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Pharmacy, UPMC, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, Department of Biomedical Informatics, School of Medicine and the Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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4
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Tashiro M, Obata Y, Takazono T, Ota Y, Wakamura T, Shiozawa Y, Tsuyuki A, Miyazaki T, Nishino T, Izumikawa K. Association between fluid infusions and the recovery from acute kidney injury in patients administered liposomal amphotericin B: a nationwide observational study. Ren Fail 2022; 44:282-292. [PMID: 35172680 PMCID: PMC8856109 DOI: 10.1080/0886022x.2022.2036618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute kidney injury (AKI) often develops during the administration of liposomal amphotericin B (L-AMB), a broad-spectrum antifungal drug. However, clinical recovery approaches for AKI patients administered L-AMB are not well established. This retrospective analysis used the data obtained from hospitals throughout Japan. AKI was defined as a ≥ 1.5-fold increase within 7 days or ≥0.3 mg/dL increase within 2 days in serum creatinine. AKI recovery was defined as a return to creatinine levels below or equal to those recorded before AKI onset. Ninety patients were assessed for recovery from AKI as per the three stages. The incidence of recovery from AKI regardless of its stage was higher, though not significant, in patients administered ≥10 mL/kg/day fluid for 7 consecutive days from AKI onset (63%) than in those who did not (35%, p = 0.053). However, if limited to AKI stage 1 patients, the former group had a significantly higher incidence of recovery (91%) than the latter group (50%, p = 0.017), even after adjusting for confounding factors (odds ratio: 10.135, 95% confidence interval: 1.148–89.513, p = 0.037). The daily fluid volume administered during the 7 consecutive days from AKI onset positively correlated with the recovery from AKI of all stages (p = 0.043). Daily consecutive fluid infusion from AKI onset may be associated with recovery from stage 1 AKI in patients administered L-AMB, with daily fluid volume positively correlating with the incidence of AKI recovery.
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Affiliation(s)
- Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Yoko Obata
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan.,Department of Nephrology, Sasebo City General Hospital, Nagasaki, Japan
| | - Tomotaro Wakamura
- Medical Affairs Division, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | | | - Ai Tsuyuki
- Deloitte Tohmatsu Consulting LLC, Tokyo, Japan
| | - Taiga Miyazaki
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
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5
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Gursoy V, Ozkalemkas F, Ozkocaman V, Serenli Yegen Z, Ethem Pinar I, Ener B, Akalın H, Kazak E, Ali R, Ersoy A. Conventional Amphotericin B Associated Nephrotoxicity in Patients With Hematologic Malignancies. Cureus 2021; 13:e16445. [PMID: 34422476 PMCID: PMC8367387 DOI: 10.7759/cureus.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection. Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively. Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m² days 1-7, Idarubicin 12 mg/m² days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process. Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.
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Affiliation(s)
- Vildan Gursoy
- Division of Hematology, Department of Internal Medicine, Medical School of Usak University, Usak, TUR
| | - Fahir Ozkalemkas
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Vildan Ozkocaman
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | | | - Ibrahim Ethem Pinar
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Beyza Ener
- Department of Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Esra Kazak
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Alparslan Ersoy
- Division of Nephrology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
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6
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Panahi-Shokouh M, Moghaddas A, Badri S, Jabalameli S, Momenzadeh M, Mehrzad V, Ashrafi F. Pentoxifylline in Prevention of Amphotericin B-induced Nephrotoxicity and Electrolyte Abnormalities. J Res Pharm Pract 2021; 9:135-139. [PMID: 33489981 PMCID: PMC7808184 DOI: 10.4103/jrpp.jrpp_20_98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/02/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: Amphotericin B is an antifungal agent used to treat serious fungal infections mainly in critically ill patients. Despite its adverse effects including renal toxicity and electrolyte imbalances, amphotericin B remains one of the best choices for antifungal treatment. Information from animal studies has provided a strong scientific basis for the use of pentoxifylline as lowering nephroprotective agent. The present study was designed to evaluate the efficacy of pentoxifylline in preventing renal toxicity and electrolytes imbalances induced by amphotericin B. Methods: This study was conducted as a randomized controlled trial on 44 patients admitted to Sayyedoshohada Hospital, Isfahan, Iran, from October 2016 to August 2018. Patients were assigned to one of the two groups: Pentoxifylline, 400 mg twice a day, or matching placebo, from the 1st day of amphotericin B therapy till minimum of 7 days. All patients' information including lab data (serum and urine levels of Mg, Na, and K, serum creatinine level, blood urea nitrogen [BUN] and urinary creatinine excretion) were gathered at the time of drug initiation and during the study period. The results were analyzed by SPSS v. 20 software and Repeated measures test was used to assess the differences between groups Findings: This study did not show any significant differences between the two groups in terms of all the assessed variables, including serum and urinary levels of electrolytes, and creatinine, as well as the number of cases presented acute kidney injury during the study period. Conclusion: Despite the positive effects of pentoxifylline in preventing renal complications in previous studies, this study could not show a definitive result in salt wasting or renal damage induced by amphotericin B. So, Designing robust studies with more included samples would be valuable.
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Affiliation(s)
- Mahsa Panahi-Shokouh
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Moghaddas
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeedeh Jabalameli
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Momenzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Mehrzad
- Department of Oncology/Hematology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Ashrafi
- Department of Oncology/Hematology, Isfahan University of Medical Sciences, Isfahan, Iran
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7
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Karimzadeh I, Sepehr-Sobhani A, Khoshnoud MJ, Sagheb MM, Vejdani R, Jalali A, Mahi-Birjand M. Comparison of intravenous sodium bicarbonate and sodium chloride combination versus intravenous sodium chloride hydration alone in reducing amphotericin B nephrotoxicity: a randomized clinical trial. Res Pharm Sci 2020; 15:583-591. [PMID: 33828601 PMCID: PMC8020849 DOI: 10.4103/1735-5362.301343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/04/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background and purpose: The most important adverse reaction of amphotericin B (AmB) is nephrotoxicity. The aim of this study was to assess the potential effectiveness of intravenous saline + sodium bicarbonate versus intravenous sodium chloride hydration in preventing or attenuating AmB nephrotoxicity. Experimental approach: A randomized, non-placebo-controlled, single-blinded clinical trial was conducted in two adult hematology-oncology wards of Namazi hospital. Eligible patients were randomly assigned into either the normal saline or normal saline + sodium bicarbonate groups by the ratio of 1:2. In the normal saline group, 1000 mL of sodium chloride 0.9% (154 meq sodium) was given intravenously as two equal 500 mL volumes before and during the infusion of AmB. Patients in the saline + sodium bicarbonate group received 500 mL sodium chloride 0.9% (72 meq sodium) before and 500 mL isotonic sodium bicarbonate (72 meq sodium) intravenously during AmB infusion. Findings/Results: The rate of AmB nephrotoxicity was comparable between normal saline and sodium bicarbonate groups (54.2% and 41.6%, respectively; P = 0.3). This difference did not reach the level of statistical significance after considering AmB dose and duration of the treatment. The frequency of hypokalemia and hypomagnesemia did not differ significantly between the two groups even after adjusting the results according to AmB dose and treatment duration. Conclusion and implications: The results of the current preliminary clinical trial suggested that the combination of sodium bicarbonate and normal saline compared to normal saline alone appears to have no superiority in preventing or attenuating different studied aspects of AmB nephrotoxicity in patients with hematological malignancies.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Asma Sepehr-Sobhani
- Department of Pharmacology-Toxicology, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Mohammad Javad Khoshnoud
- Department of Pharmacology-Toxicology, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran.,Food and Supplements Research Center, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Mohammad Mahdi Sagheb
- Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, I.R. Iran
| | - Reza Vejdani
- Hematology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, I.R. Iran
| | - Atefeh Jalali
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Motahareh Mahi-Birjand
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, I.R. Iran.,Department of Clinical Pharmacy, Faculty of pharmacy, Birjand University of Medical Sciences, Birjand, I.R. Iran
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8
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Ambreen G, Rehman A, Hussain K, Sohail M, Javed S, Shamim S, Ali U, Ahmad K, Rizvi A. Neonatal fluid and electrolytes profile effect on amphotericin B associated nephrotoxicity in neonatal tertiary care unit of Karachi-Pakistan. Expert Opin Drug Saf 2020; 19:1209-1217. [PMID: 32544349 DOI: 10.1080/14740338.2020.1781813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates. METHODS In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG). RESULTS A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly (p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91-0.99), (phase-II: AOR: 0.84; 95% CI: 0.68-0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86-0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy. CONCLUSIONS Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.
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Affiliation(s)
- Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Arshalooz Rehman
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
| | - Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Mehreen Sohail
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Saba Javed
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Syed Shamim
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Umer Ali
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Khalil Ahmad
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
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9
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Abstract
BACKGROUND Progressive disseminated histoplasmosis (PDH) is a serious fungal infection that affects people living with HIV. The best way to treat the condition is unclear. OBJECTIVES We assessed evidence in three areas of equipoise. 1. Induction. To compare efficacy and safety of initial therapy with liposomal amphotericin B versus initial therapy with alternative antifungals. 2. Maintenance. To compare efficacy and safety of maintenance therapy with 12 months of oral antifungal treatment with shorter durations of maintenance therapy. 3. Antiretroviral therapy (ART). To compare the outcomes of early initiation versus delayed initiation of ART. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane CENTRAL; MEDLINE (PubMed); Embase (Ovid); Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and BIOSIS Previews (all three in the Web of Science); the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry, all up to 20 March 2020. SELECTION CRITERIA We evaluated studies assessing the use of liposomal amphotericin B and alternative antifungals for induction therapy; studies assessing the duration of antifungals for maintenance therapy; and studies assessing the timing of ART. We included randomized controlled trials (RCT), single-arm trials, prospective cohort studies, and single-arm cohort studies. DATA COLLECTION AND ANALYSIS Two review authors assessed eligibility and risk of bias, extracted data, and assessed certainty of evidence. We used the Cochrane 'Risk of bias' tool to assess risk of bias in randomized studies, and ROBINS-I tool to assess risk of bias in non-randomized studies. We summarized dichotomous outcomes using risk ratios (RRs), with 95% confidence intervals (CI). MAIN RESULTS We identified 17 individual studies. We judged eight studies to be at critical risk of bias, and removed these from the analysis. 1. Induction We found one RCT which compared liposomal amphotericin B to deoxycholate amphotericin B. Compared to deoxycholate amphotericin B, liposomal amphotericin B may have higher clinical success rates (RR 1.46, 95% CI 1.01 to 2.11; 1 study, 80 participants; low-certainty evidence). Compared to deoxycholate amphotericin B, liposomal amphotericin B has lower rates of nephrotoxicity (RR 0.25, 95% CI 0.09 to 0.67; 1 study, 77 participants; high-certainty evidence). We found very low-certainty evidence to inform comparisons between amphotericin B formulations and azoles for induction therapy. 2. Maintenance We found no eligible study that compared less than 12 months of oral antifungal treatment to 12 months or greater for maintenance therapy. For both induction and maintenance, fluconazole performed poorly in comparison to other azoles. 3. ART We found one study, in which one out of seven participants in the 'early' arm and none of the three participants in the 'late' arm died. AUTHORS' CONCLUSIONS Liposomal amphotericin B appears to be a better choice compared to deoxycholate amphotericin B for treating PDH in people with HIV; and fluconazole performed poorly compared to other azoles. Other treatment choices for induction, maintenance, and when to start ART have no evidence, or very low certainty evidence. PDH needs prospective comparative trials to help inform clinical decisions.
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Affiliation(s)
- Marylou Murray
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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10
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Downes KJ, Hayes M, Fitzgerald JC, Pais GM, Liu J, Zane NR, Goldstein SL, Scheetz MH, Zuppa AF. Mechanisms of antimicrobial-induced nephrotoxicity in children. J Antimicrob Chemother 2020; 75:1-13. [PMID: 31369087 PMCID: PMC6910165 DOI: 10.1093/jac/dkz325] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Drug-induced nephrotoxicity is responsible for 20% to 60% of cases of acute kidney injury in hospitalized patients and is associated with increased morbidity and mortality in both children and adults. Antimicrobials are one of the most common classes of medications prescribed globally and also among the most common causes of nephrotoxicity. A broad range of antimicrobial agents have been associated with nephrotoxicity, but the features of kidney injury vary based on the agent, its mechanism of injury and the site of toxicity within the kidney. Distinguishing nephrotoxicity caused by an antimicrobial agent from other potential inciting factors is important to facilitate both early recognition of drug toxicity and prompt cessation of an offending drug, as well as to avoid unnecessary discontinuation of an innocuous therapy. This review will detail the different types of antimicrobial-induced nephrotoxicity: acute tubular necrosis, acute interstitial nephritis and obstructive nephropathy. It will also describe the mechanism of injury caused by specific antimicrobial agents and classes (vancomycin, aminoglycosides, polymyxins, antivirals, amphotericin B), highlight the toxicodynamics of these drugs and provide guidance on administration or monitoring practices that can mitigate toxicity, when known. Particular attention will be paid to paediatric patients, when applicable, in whom nephrotoxin exposure is an often-underappreciated cause of kidney injury.
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Affiliation(s)
- Kevin J Downes
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Molly Hayes
- Antimicrobial Stewardship Program, Center for Healthcare Quality & Analytics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie C Fitzgerald
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gwendolyn M Pais
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Jiajun Liu
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Nicole R Zane
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Marc H Scheetz
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
- Pharmacometrics Center of Excellence, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
- Department of Pharmacology, College of Graduate Studies, Midwestern University, Downers Grove, IL, USA
| | - Athena F Zuppa
- Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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11
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Effect of resveratrol and Regrapex-R-forte on Trichosporon cutaneum biofilm. Folia Microbiol (Praha) 2018; 64:73-81. [PMID: 30062620 DOI: 10.1007/s12223-018-0633-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/12/2018] [Indexed: 01/21/2023]
Abstract
Microorganisms that cause chronic infections exist predominantly as surface-attached stable communities known as biofilms. Microbial cells in biofilms are highly resistant to conventional antibiotics and other forms of antimicrobial treatment; therefore, modern medicine tries to develop new drugs that exhibit anti-biofilm activity. We investigated the influence of a plant polyphenolic compound resveratrol (representative of the stilbene family) on the opportunistic pathogen Trichosporon cutaneum. Besides the influence on the planktonic cells of T. cutaneum, the ability to inhibit biofilm formation and to eradicate mature biofilm was studied. We have tested resveratrol as pure compound, as well as resveratrol in complex plant extract-the commercially available dietary supplement Regrapex-R-forte, which contains the extract of Vitis vinifera grape and extract of Polygonum cuspidatum root. Regrapex-R-forte is rich in stilbenes and other biologically active substances. Light microscopy imaging, confocal microscopy, and crystal violet staining were used to quantify and visualize the biofilm. The metabolic activity of biofilm-forming cells was studied by the tetrazolium salt assay. Amphotericin B had higher activity against planktonic cells; however, resveratrol and Regrapex-R-forte showed anti-biofilm effects, both in inhibition of biofilm formation and in the eradication of mature biofilm. The minimum biofilm eradicating concentration (MBEC80) for Regrapex-R-forte was found to be 2222 mg/L (in which resveratrol concentration is 200 mg/L). These methods demonstrated that Regrapex-R-forte can be employed as an anti-biofilm agent, as it has similar effect as amphotericin B (MBEC80 = 700 mg/L), which is routinely used in clinical practice.
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Andrew EC, Curtis N, Coghlan B, Cranswick N, Gwee A. Adverse effects of amphotericin B in children; a retrospective comparison of conventional and liposomal formulations. Br J Clin Pharmacol 2018; 84:1006-1012. [PMID: 29352486 DOI: 10.1111/bcp.13521] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 01/10/2023] Open
Abstract
AIMS Lipid formulations of amphotericin B, rather than conventional amphotericin (c-amB), are increasingly used despite limited data comparing these preparations in children. Data on the incidence of adverse effects with amphotericin B at standard doses are scarce. This study aimed to compare the adverse effects associated with standard doses of c-amB and liposomal amphotericin (l-amB) in children. METHODS Children admitted to the Royal Children's Hospital Melbourne and treated with c-amB or l-amB between January 2010 and September 2013 were included. Clinical and laboratory data were retrospectively extracted from medical records to compare amphotericin-related infusion reactions, nephrotoxicity (glomerulotoxicity and tubulopathy) and hepatotoxicity. RESULTS Seventy-six children received c-amB and 39 received l-amB. Standard drug administration (recommended dose and infusion time) occurred in 74% (56/76) of patients on c-amB and 85% (33/39) on l-amB. In these 89 children, infusion-related reactions were similar for both c-amB and l-amB (23% (13/56) vs. 9% (3/33); P = 0.15); none occurred in children aged <90 days. There was no difference in amphotericin-associated glomerulotoxicity (c-amB 14% (8/56) vs. l-amB 21% (7/33); P = 0.40) or in the median maximum potassium requirements (c-amB 3.1 vs. l-amB 2.3 mmol kg-1 d-1 ; P = 0.29). Hepatotoxicity occurred more frequently with l-amB than c-amB (83% (24/29) vs. 56% (20/36); P = 0.032). CONCLUSIONS When appropriately administered, l-amB was associated with more hepatotoxicity than c-amB, with no difference in infusion-related reactions or nephrotoxicity. Differences in adverse effects between the preparations is not as marked in children as reported in adults.
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Affiliation(s)
- Eden C Andrew
- Infectious Diseases and Clinical Pharmacology Units, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases and Clinical Pharmacology Units, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases & Microbiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ben Coghlan
- The Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.,School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Noel Cranswick
- Infectious Diseases and Clinical Pharmacology Units, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases & Microbiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Gwee
- Infectious Diseases and Clinical Pharmacology Units, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases & Microbiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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13
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Karimzadeh I, Heydari M, Ramzi M, Sagheb MM. Frequency and Associated Factors of Amphotericin B Nephrotoxicity in Hospitalized Patients in Hematology-Oncology Wards in the Southwest of Iran. Nephrourol Mon 2016; 8:e39581. [PMID: 27896234 PMCID: PMC5119430 DOI: 10.5812/numonthly.39581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022] Open
Abstract
Background Nephrotoxicity is the most clinically significant adverse reaction of amphotericin B. Different aspects of amphotericin B (AmB) nephrotoxicity have not been studied well in our population. Objectives The purpose of this study was to assess the frequency, time onset, and possible associated factors of AmB nephrotoxicity in hospitalized patients in hematology-oncology wards in the southwest of Iran. Patients and Methods A cross-sectional, observational study was performed over a period of 9 months at 2 hematology-oncology and 1 hematopoietic stem cell transplantation wards at Namazi Hospital. Patients aged 15 years or older with no documented history of acute kidney injury or chronic kidney disease who were scheduled to receive formulations of AmB intravenously for at least 1 week were included. The required demographic and clinical data of the patients were recorded. Urine urea, creatinine, sodium, potassium, and magnesium levels were measured at days 0, 3, 5, 7, 10, and 14 of the AmB treatment. AmB nephrotoxicity based on serum creatinine increase, renal potassium wasting, hypokalemia, and hypomagnesemia were determined. Results Among the 40 patients recruited for the study, 11 (27.5%) patients developed AmB nephrotoxicity with a mean ± standard deviation onset of 6.73 ± 2.36 days. In 5 patients, AmB nephrotoxicity resolved spontaneously without any intervention. According to the multivariate logistic regression model, none of the studied demographic, clinical, and paraclinical variables were significantly associated with AmB nephrotoxicity. The duration of hospitalization (P = 0.541) and the mortality rate (P = 0.723) were comparable between the patients with and without AmB nephrotoxicity. Hypokalemia and renal potassium wasting were identified in 45% and 27.5% of the patients during AmB treatment, respectively. Conclusions Nearly one-third (27.5%) of our cohort developed nephrotoxicity within the first week of AmB treatment. Hypokalemia and renal potassium wasting were more notable, affecting about one-half and one-third of the AmB recipients, respectively.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Marziyeh Heydari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mani Ramzi
- Hematology Research Center, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Mahdi Sagheb
- Nephrology-Urology Research Center, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Mohammad Mahdi Sagheb, Nephrology-Urology Research Center, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132351087, E-mail:
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14
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de Souza MCP, Santos AGD, Reis AMM. Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High-Complexity Hospital. J Clin Pharmacol 2016; 56:1507-1515. [PMID: 27198583 DOI: 10.1002/jcph.772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/07/2016] [Accepted: 05/14/2016] [Indexed: 11/06/2022]
Abstract
The aim of the present study was to determine the frequency of adverse drug reactions (ADRs) associated with the use of systemic antifungal drugs in patients hospitalized at a high-complexity hospital. In addition, factors associated with ADRs were investigated. This cross-sectional retrospective study involved the investigation of 183 medical records of patients receiving systemic antifungal therapy. Antifungal drugs were classified using the fourth level of the Anatomical Therapeutic Chemical System. ADR causality was classified using the Naranjo algorithm. Drug interactions were assessed using DRUG-REAX software. Data were analyzed with descriptive statistics and univariate and multivariate logistic regression. A total of 53 patients (29.0%) had at least 1 ADR involving antifungals. Ninety-six ADRs were detected. The main ADRs observed were an infusion reaction in 24 patients (25.0%), hypokalemia in 22 (22.9%), nephrotoxicity in 18 (18.7%), and hepatotoxicity in 15 (15.6%). Amphotericin B and voriconazole were associated with ADRs of major clinical impact. Eleven of the ADRs (11.4%) were related to drug interactions. The following 3 factors were contributors to the multivariate model for the occurrence of ADRs caused by antifungal drug use: neoplasm diagnosis (odds ratio [OR], 3.9; 1.9-7.9), length of hospital stay (OR, 2.2; 1.1-4.5), and the use of ≥13 drugs (OR, 3.4; 1.6-7.2). Our study revealed positive associations between the occurrence of ADRs and diagnosis of a neoplasm, the length of stay, and the use of multiple drugs concomitant with antifungals. These risk factors should be considered in antifungal stewardship, among other actions, to promote the rational use of antifungal agents.
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Affiliation(s)
- Maria Clara Padovani de Souza
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.,Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Andrezza Gouvêa Dos Santos
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.,Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Adriano Max Moreira Reis
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.,Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
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Schlottfeldt FDS, Fernandes SM, Martins DM, Cordeiro P, Fonseca CDD, Watanabe M, Vattimo MDFF. Prevenção da nefrotoxicidade da anfotericina B por meio do uso de fitomedicamentos. Rev Esc Enferm USP 2015; 49 Spec No:74-9. [DOI: 10.1590/s0080-623420150000700011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Avaliar ação renoprotetora dos flavonoides diosmina e hesperidina na prevenção da nefrotoxicidade da anfotericina B em modelo experimental com ratos. Método Ratos Wistar, adultos, machos foram distribuídos nos seguintes grupos: Salina; diosmina hesperidina (animais receberam 50 mg/kg de diosmina hesperidina em água de bebedouro por dez dias); Anfotericina B (animais receberam 15 mg/kg/dia de anfotericina B intraperitoneal por cinco dias); Anfotericina B+diosmina hesperidina. Foram avaliados função renal, fração de excreção de sódio, potássio e magnésio e os metabólitos oxidativos. Resultados O tratamento com anfotericina B reduziu a função renal, vista peloclearance de creatinina, elevou os marcadores de função tubular como a fração de excreção de sódio, potássio, magnésio e dos metabólitos oxidativos. O pré-condicionamento com diosmina hesperidina elevou o clearance de creatinina e atenuou da lesão tubular e oxidativa. Conclusão A administração de anfotericina B resultou no declínio da função renal com lesão tubular e a diosmina hesperidina demonstrou efeito renoprotetor antioxidante.
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Evaluation of baicalein, chitosan and usnic acid effect on Candida parapsilosis and Candida krusei biofilm using a Cellavista device. J Microbiol Methods 2015; 118:106-12. [DOI: 10.1016/j.mimet.2015.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/04/2015] [Accepted: 09/05/2015] [Indexed: 11/21/2022]
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17
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Karimzadeh I, Khalili H, Sagheb MM, Farsaei S. A double-blinded, placebo-controlled, multicenter clinical trial ofN-acetylcysteine for preventing amphotericin B-induced nephrotoxicity. Expert Opin Drug Metab Toxicol 2015; 11:1345-55. [DOI: 10.1517/17425255.2015.1042363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Jain K, Mehra NK, Jain NK. Potentials and emerging trends in nanopharmacology. Curr Opin Pharmacol 2014; 15:97-106. [PMID: 24598376 DOI: 10.1016/j.coph.2014.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
Nanopharmacology is a relatively newer branch of pharmacology which investigates interaction of a nanomedicine with living systems at the nanoscale level. Modern medicine is increasingly concerned with various surface modified nanocarriers, such as dendrimers, nanoparticles, carbon based nanomaterials, polymer-drug nanoconjugates, etc., which have immense therapeutic potential by target specific drug delivery, using nanoscaffolding and nanocontainers, owing to the specific physical, chemical and biological properties of these moieties that is related to their nanoscale size range. Nanopharmacology could have potential medical and pharmaceutical benefits via applications of nanotechnology in the delivery of therapeutic and diagnostic agents. Nanomaterials may be expected to find application in the cardiovascular, as well as, renal arena, in the near future.
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Affiliation(s)
- Keerti Jain
- Pharmaceutics Research Laboratory, Department of Pharmaceutical Sciences, Dr. H. S. Gour Central University, Sagar, Madhya Pradesh 470003, India
| | - Neelesh Kumar Mehra
- Pharmaceutics Research Laboratory, Department of Pharmaceutical Sciences, Dr. H. S. Gour Central University, Sagar, Madhya Pradesh 470003, India
| | - Narendra Kumar Jain
- Pharmaceutics Research Laboratory, Department of Pharmaceutical Sciences, Dr. H. S. Gour Central University, Sagar, Madhya Pradesh 470003, India.
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Karimzadeh I, Khalili H, Dashti-Khavidaki S, Sharifian R, Abdollahi A, Hasibi M, Khazaeipour Z, Farsaei S. N-acetyl cysteine in prevention of amphotericin- induced electrolytes imbalances: a randomized, double-blinded, placebo-controlled, clinical trial. Eur J Clin Pharmacol 2014; 70:399-408. [PMID: 24445685 DOI: 10.1007/s00228-014-1642-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/01/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of oral n-acetyl cysteine, as a potential nephroprotective agent, in preventing and/or attenuating amphotericin B-induced electrolytes imbalances. METHODS During a one year period, patients were to receive conventional amphotericin b for any indication for at least one week and were randomly allocated to receive either placebo or 600 mg oral n-acetyl cysteine twice daily during the treatment course of amphotericin b. Demographic and clinical data of the study population were gathered. Different aspects of amphotericin b nephrotoxicity including decrease of glomerular filtration rate, hypokalemia, hypomagnesemia, renal magnesium and potassium wasting were assessed. Each patient was monitored for any adverse reaction to n-acetyl cysteine. Sixteen and 14 patients in the n-acetyl cysteine and placebo groups completed the study, 3incidences of hypokalemia (75 % versus 70 %; P = 0.724) and hypomagnesemia (30 % versus 20 %; P = 0.468) did not differ significantly between placebo and NAC groups, respectively. Although the rate of AmB nephrotoxicity was higher in the placebo than in the NAC group (60 % versus 40 %), this difference was not statistically significant (P = 0.209) even after adjusting for probable associated factors of amphotericin b nephrotoxicity (P = 0.206). The incidence as well as time of onset of electrolyte abnormalities also did not differ significantly between placebo and n-acetyl cysteine groups. About 44 % of n-acetyl cysteine recipients experienced new onset nausea and a mild unpleasant taste during the study. CONCLUSION Oral n-acetyl cysteine during the amphotericin B treatment course was not significantly effective in preventing or mitigating different features of its nephrotoxicity including decrease of glomerular filtration rate, hypokalemia, hypomagnesemia, and renal potassium as well as magnesium wasting.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, 1417614411, P.O. Box:14155/6451, Enghelab Ave, Tehran, Iran,
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