• Roberto Palermo Uehara, Victor Hugo Lara de Sá, Erika Tae Koshimura, Fernanda Vilas Boas Prudente, Luciana Tomanik Cardozo de Mello Tucunduva, Marina Sahade Gonçalves, Eliana Sueco Tibana Samano, and Auro del Giglio.
• Faculdade de Medicina, Fundação ABC, Hospital Estadual Mário Covas, Santo André, São Paulo, Brazil.
• Sao Paulo Med J. 2005 Sep 1; 123 (5): 219222219-22.

Context And ObjectiveIntravenous amphotericin B deoxycholate (AmB-D) infusions, usually given over 4 hours, frequently induce nephrotoxicity and undesirable infusion-related side effects such as rigors and chills. There is evidence in the literature that the use of AmB-D in the form of continuous 24-hour infusion is less toxic than the usual four-hour infusion of this drug. Our objective was to evaluate the efficacy and safety of continuous infusion of AmB-D for the treatment of persistent fever in neutropenic patients with hematological malignancies after chemotherapy.Design And SettingObservational retrospective analysis of our experience with continuous infusion of AmB-D, at Faculdade de Medicina da Fundação ABC and Hospital Estadual Mário Covas in Santo André.MethodsFrom October 2003 to May 2004, 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous infusion of AmB-D.ResultsThe median dose of AmB-D was 0.84 mg/kg/day (0.33 to 2.30 mg/kg/day). Concomitant use of nephrotoxic medications occurred in 92% of the cycles. Nephrotoxicity occurred in 30.76% of the cycles, hypokalemia in 16.67%, hepatotoxicity in 30% and adverse infusion-related events in 23%. All patients survived for at least seven days after starting continuous infusion of AmB-D, and clinical resolution occurred in 76% of the cycles.ConclusionsContinuous infusion of AmB-D can be used in our Institution as an alternative to the more toxic four-hour infusion of AmB-D and possibly also as an alternative to the more expensive liposomal formulations of the drug.

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