AMPHOTERICIN-B INFUSION-RELATED TOXICITY - COMPARISON OF 2-HOUR AND 4-HOUR INFUSIONS

OBJECTIVE: To investigate the influence of infusion duration on infusi on-related adverse effects (IRAEs) associated with prophylactic or tre atment regimens of amphotericin B in patients with leukemia/bone marro w transplant (BMT). DESIGN: Randomized, double-blind, 2-arm, complete crossover, prospective clinical trial. SETTING: A university-affiliate d tertiary care teaching hospital. PARTICIPANTS: The study population consisted of 25 consecutive patients with leukemia/BMT who received 16 2 prophylactic regimen infusions and 169 treatment regimen infusions o f amphotericin B via a central line, Prior to each infusion all patien ts received a parenteral IRAE prophylaxis regimen of diphenhydramine 2 5 mg and hydrocortisone 25 mg, No test doses or incremental amphoteric in B doses were administered. Patients were monitored closely for IRAE s, which were documented by using a standardized data collection form. MAIN OUTCOME MEASURES: The incidence and nature of IRAEs during a 6-h our monitoring period following the initiation of each infusion was me asured. Patients served as their own controls. IRAEs were compared acc ording to infusion duration and therapeutic indication. RESULTS: Three hundred and thirty-one 2- and 4-hour amphotericin B infusions were ad ministered. We found no difference between 2- and 4-hour infusions in the incidence and severity of IRAEs, including overall events (29% of 166 2-hour infusions vs. 25% of 165 4-hour infusions), chill scores (8 % of 166 2-hour infusions vs. 7% of 165 4-hour infusions; highest scor e 7 vs. 6), nausea and vomiting (7% vs. 12%; highest score 4 in both g roups), fever (3% vs. 2%), highest temperature increase (2.4 vs. 1.6 d egrees C), systolic hypotension (6% vs. 2%), greatest decrease from ba seline (40 vs. 62 mm Hg), diastolic hypotension (5% vs. 3%), and great est decrease (30 vs, 28 mm Hg) (p > 0.05). Overall, IRAEs were less co mmon in prophylactic treatment regimens (35 events [22%] in 162 infusi ons) than in treatment regimens (55 events [32%] in 169 infusions) (p < 0.05). CONCLUSIONS: This study demonstrates that patients with leuke mia/BMT without myocardial or renal dysfunction who receive hydrocorti sone and diphenhydramine as premedications can tolerate 2-hour central line infusions of prophylactic or treatment regimens of amphotericin B as well as 4-hour infusions.