1
|
O'Grady N, McManus D, Briggs N, Azar MM, Topal J, Davis MW. Dosing implications for liposomal amphotericin B in pregnancy. Pharmacotherapy 2023; 43:452-462. [PMID: 36862037 DOI: 10.1002/phar.2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 03/03/2023]
Abstract
Liposomal amphotericin B (LAmB) is used in the treatment of opportunistic fungal and parasitic infections, including leishmaniasis. Given its lack of known teratogenicity in pregnancy, LAmB is a preferred agent for treatment for these patients. However, significant gaps remain in determining optimal dosing regimens for LAmB in pregnancy. We describe the use of LAmB for a pregnant patient with mucocutaneous leishmaniasis (MCL) using a dosing strategy of 5 mg/kg/day for days 1-7 using ideal body weight followed by 4 mg/kg weekly using adjusted body weight. We reviewed the literature for LAmB dosing strategies, particularly dosing weight, in pregnancy. Of the 143 cases identified in 17 studies, only one reported a dosing weight, in which ideal body weight was used. Five Infectious Diseases Society of America guidelines in total discussed the use of amphotericin B in pregnancy but no guidelines included recommendations for dosing weight. This review describes our experience in using ideal body weight for dosing LAmB in pregnancy for the treatment of MCL. Use of ideal body weight may minimize risk of adverse effects to the fetus compared to the use of total body weight while maintaining efficacy for treatment of MCL in pregnancy.
Collapse
Affiliation(s)
- Niamh O'Grady
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Dayna McManus
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Neima Briggs
- Department of Internal Medicine, Infectious Disease Section, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Marwan M Azar
- Department of Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey Topal
- Department of Internal Medicine, Infectious Disease Section, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Matthew W Davis
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, Connecticut, USA
| |
Collapse
|
2
|
Design of double functionalized carbon nanotube for amphotericin B and genetic material delivery. Sci Rep 2022; 12:21114. [PMID: 36476955 PMCID: PMC9729229 DOI: 10.1038/s41598-022-25222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
In the present work, single wall carbon nanotubes (SWCNT) were successively functionalized with phospholipid DSPE-PEG carboxylic acid, and then, with ethylenediamine (EDA), to obtain double functionalized single wall carbon nanotube (DFSWCNT). Then, DFSWCNT was applied as a carrier for delivering amphotericin B (Amb) and EGFP plasmid. FSWCNT's concentration obtained via UV-visible analysis was 0.99 mg/mL. The TGA analysis results provided the lost weights of DSPE-PEG-COOH, EDA, Amb and SWCNT impurities. XPS results showed that carbon atoms' percentage decreased during the functionalization processes from 97.2% (SWCNT) to 76.4% (FSWCNT) and 69.9% (DFSWNCT). Additionally, the oxygen atoms' percentage increased from 2.3% (SWCNT) to 21% and 22.5% for FSWCNT and DFSWCNT, respectively. New bonds such as C-N and N-C=O appeared in the synthesized nanocarrier. The IG/ID ratio in Raman analysis decreased from 7.15 (SWCNT) to 4.08 (FSWCNT). The amount of Amb released to phosphate buffer saline medium was about 33% at pH = 5.5 and 75% at pH = 7.4 after 48 h. CCK8 results confirmed that the toxicity of functionalized SWCNT had decreased. In a 2:1 ratio of DFSWCNT/EGFP plasmid, the cell viability (87%) and live transfected cells (56%) were at their maximum values. The results indicate that carbon nanotubes have the potential to be applied as drug/gene delivery systems with outstanding properties such as high loading capacity and easy penetration to cell membrane.
Collapse
|
3
|
Gould AP, Winders HR, Stover KR, Bookstaver PB, Griffin B, Bland CM, Eiland LS, Murray M. Less common bacterial, fungal and viral infections: review of management in the pregnant patient. Drugs Context 2021; 10:dic-2021-4-3. [PMID: 34603460 PMCID: PMC8462995 DOI: 10.7573/dic.2021-4-3] [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: 04/23/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022] Open
Abstract
This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A β-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for Pneumocystis pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions.
Collapse
Affiliation(s)
| | - Hana R Winders
- University of South Carolina College of Pharmacy, Columbia, SC, USA.,Prisma Health Midlands, Columbia, SC, USA
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, MS, USA
| | | | - Brooke Griffin
- Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | | | - Lea S Eiland
- Auburn University Harrison School of Pharmacy, Meridian, MS, USA
| | - Milena Murray
- Midwestern University College of Pharmacy, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
| |
Collapse
|
4
|
Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy. Antimicrob Agents Chemother 2021; 65:AAC.01876-20. [PMID: 33846129 DOI: 10.1128/aac.01876-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/21/2021] [Indexed: 11/20/2022] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) is a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting; however, data are limited describing the use and safety of liposomal amphotericin B (L-AMB). Records of patients receiving L-AMB OPAT between 1/1/2015 and 7/31/2018 were retrospectively reviewed. The primary objective was to describe the OPAT patient population discharged on L-AMB and evaluate factors associated with readmission and adverse events (AEs). Analysis was performed to evaluate for predictors of worse outcomes. Forty-two patients (67% male, median age 50 years) were identified, most of whom were treated for histoplasmosis. The most common doses of L-AMB were 3 mg/kg (n = 16, 38%) or 5 mg/kg (n = 14, 33%) based on actual body weight. Twenty-six (62%) patients completed their anticipated course of L-AMB. Twenty-two (52%) patients were readmitted within 30 days of discharge; median time to readmission was 11 days (interquartile range [IQR] 5 to 18). While hypokalemia and acute kidney injury (AKI) were common, occurring in 26 (62%) and 20 (48%) patients, respectively, only 5 (12%) were readmitted to the hospital due to L-AMB-associated AEs. Ninety percent of patients achieved at least partial renal recovery within 30 days after L-AMB discontinuation. Factors significantly associated with AKI include higher L-AMB dose, lower serum potassium levels after therapy initiation, and receipt of potassium supplementation at discharge. L-AMB is associated with significant AEs; however, these results suggest that treatment is feasible in the outpatient setting with close monitoring, as the majority of AEs were managed effectively in an outpatient without long-term sequelae.
Collapse
|
5
|
Schiave LA, Nascimento E, Gaspar GG, Vilar FC, Martinez EZ, Gaitani CMD, Martinez R. Minimum concentration of Amphotericin B in serum according to the formulation, dose, and daily or prolonged intermittent therapeutic regimen. Rev Soc Bras Med Trop 2020; 53:e20180463. [PMID: 32049198 PMCID: PMC7083383 DOI: 10.1590/0037-8682-0463-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/16/2019] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its
maximum concentration in blood; however, trough levels may be useful in
intermittent regimens of this antifungal drug. METHODS: High performance liquid chromatography (HPLC) was used to determine the
minimum concentration (Cmin) of amphotericin B in the serum of patients
receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the
treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8),
paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin,
but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean
Cmin tended to decrease with a reduction in the dose and frequency of
intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263
ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week).
The impact on Cmin was variable in patients whose dose or therapeutic scheme
was changed, especially when administered the intermittent infusion of
amphotericin B. The mean Cmin for each L-AmB schedule of intermittent
therapy was equal or higher than the minimum inhibitory concentration of
amphotericin B against Cryptococcus isolates from 10/12
patients. The Cmin of amphotericin B in patients with cryptococcal
meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic
potential of its intermittent use including in the consolidation phase of
neurocryptococcosis treatment, despite the great variability in serum levels
among patients.
Collapse
Affiliation(s)
- Leticia Aparecida Schiave
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Erika Nascimento
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Gilberto Gambero Gaspar
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Fernando Crivelenti Vilar
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Edson Zangiacomi Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Medicina Social, Ribeirão Preto, SP, Brasil
| | | | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| |
Collapse
|
6
|
Santosh T, Kothari K, Singhal SS, Shah VV, Patil R. Disseminated histoplasmosis in an immunocompetent patient - utility of skin scrape cytology in diagnosis: a case report. J Med Case Rep 2018; 12:7. [PMID: 29325597 PMCID: PMC5765674 DOI: 10.1186/s13256-017-1543-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022] Open
Abstract
Background Histoplasma capsulatum is a dimorphic fungus predominately found in soils enriched with bird and bat excreta. Although several cases of histoplasmosis have been reported in India, diagnosis using cytology has been done in very few cases. Case presentation We report here a case of disseminated histoplasmosis in a 46-year-old Indian man. Conclusion Skin scrape cytology is a simple, safe, and rapid technique to establish the initial diagnosis, thus promoting early treatment and favorable outcome, in cutaneous fungal infections.
Collapse
Affiliation(s)
- Tummidi Santosh
- Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India.
| | - Kanchan Kothari
- Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Shruti S Singhal
- Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Vyoma V Shah
- Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India
| | - Roshni Patil
- Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, 400012, India
| |
Collapse
|