Risk factors for amphotericin B-associated nephrotoxicity
Article Abstract:
Amphotericin B is the primary drug used in the treatment of certain life-threatening fungal infections. However, it has long been recognized that a side-effect of this drug may be nephrotoxicity (toxic effect on the kidney). This toxicity may take the form of several conditions which impair kidney function: constriction of the arteries serving the kidneys, damage to the smooth muscle cells of the kidneys and calcium depositions in the kidney tubules. To isolate factors that may increase the risk for amphotericin B nephrotoxicity, 113 patients who were receiving intravenous amphotericin B were studied. Thirty-five patients developed nephrotoxicity; they were compared to a control group of 60 patients who did not develop nephrotoxicity. One of the principal factors placing these patients at high risk was the dosage of the drug. For each 0.10 mg/kg/day (milligram per kilogram per day) increment in dosage over an average daily dose, there was a 1.8-fold increase in the risk for nephrotoxicity. The total dose during the course of treatment was also significant, with the risk increasing 3.7 fold for each additional 50 mg administered during a fixed period of therapy, and a 0.4 fold increase for each extra day of therapy. The administration of diuretics during amphotericin therapy increased the risk for nephrotoxicity by 12.5 fold. Another significant risk factor was an abnormal baseline serum creatinine level. (Creatinine is an amino acid found in the kidney.) Patients with elevated creatinine levels had a 15.4-fold increase in risk. The authors conclude that in each case, clinicians should cautiously determine whether the benefits of amphotericin therapy justify the risks and avoid prescribing diuretics while the patient is receiving amphotericin. Patients with abnormal serum creatinine levels should be treated for kidney insufficiency before amphotericin is administered.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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The low risk of upper gastrointestinal bleeding in patients dispensed corticosteroids
Article Abstract:
Steroids are effective in a variety of disorders, but whether they cause peptic ulcer and bleeding in the upper gastrointestinal (GI) tract as side effects is disputed. Previous studies have suggested that this may be the case, but in some of these, the effect of the medications was not separated from that of the disorder being treated. Other studies have combined data from many other studies, and conclusions from these combined analyses have been controversial. To obtain a clearer picture of the effects of steroids on upper GI bleeding, computerized billing data from 19,880 nonhospitalized patients who were prescribed corticosteroids for asthma or dermatitis, two conditions unlikely to cause GI bleeding, were analyzed. Upper GI bleeding occurred in only 45 patients, and when duration of medication was considered, the incidence of bleeding was calculated as 2.8 per 10,000 persons per month of medication. Some patients were at a six- to eight-fold higher risk for bleeding, including those with a previous history of bleeding and those taking anticoagulants. Patients more than 60 years old, those with alcohol-related disorders, and those taking nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen) were also at higher risk for GI bleeding. The study shows that the absolute risk of upper GI bleeding associated with prescription of steroids is low, suggesting that prophylactic treatment with antacids or H2-blockers (a type of antihistamine, such as cimetidine), if given at all, should be reserved for high-risk patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Risk factors for nosocomial candidemia: a case control study in adults without leukemia
Article Abstract:
Nosocomial infections are infections acquired during hospitalization. Leukemia patients who receive chemotherapeutic drugs, which have a tendency to suppress the immune system, are at risk for developing nosocomial infections, particularly those caused by the fungus candida albicans. To determine the risk of nosocomial candida infections of the blood in non-leukemic patients, 24 patients were evaluated. The use of a central indwelling catheter, a tube inserted into a blood vessel to deliver nutritional therapy, carried the highest odds ratio (26.4) for developing a nosocomial candida infection. Other risk factors included the presence of a bladder catheter, the recent use of two or more antibiotics, the presence of high nitrogen content in the blood due to kidney failure, transfer from another hospital, diarrhea and a concurrent candida infection in the urine. A decreased risk for nosocomial candida infections was found in surgical patients. This information can be used to develop management approaches to prevent the serious sequelae of candida infection in the blood. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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