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Empirical amphotericin B therapy on day 4 or day 8 of febrile neutropenia. Mycoses 2014 Feb;57(2):110-5

Date

07/13/2013

Pubmed ID

23844563

DOI

10.1111/myc.12108

Scopus ID

2-s2.0-84892858110 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

Febrile neutropenic patients are at greater risk of getting bacterial and fungal infections. Empirical antifungal therapy is considered if the fever persists despite broad-spectrum antibiotics including vancomycin. However, the timing of initiating empirical antifungal therapy can vary from 3 to 8 days of non-response to antibiotics. We choose to determine the response of empirical amphotericin B deoxycholate (dAMB) starting either on day 4 or day 8 in febrile neutropenic patients not responding to broad-spectrum antibiotics and without localisation of fever. Fifty-six patients with persistent neutropenic fever despite 72 h of antibiotic therapy were randomly assigned to receive dAMB either starting on day 4 (group A, n = 27, median age 23 years) or starting on day 8 (group B, n = 29, median age 25 years). Satisfactory response (patient remaining afebrile for 48 h and maintaining absolute neutrophil count >500 μl(-1) ) occurred in 85.2% of patients in group A vs. 69.5% in group B (P = 0.209). Patients in group A took significantly fewer days to become afebrile than group B (5.4 ± 3.9 days vs. 11.3 ± 4.0 days, P = 0.0001). The adverse side effects of dAMB (nephrotoxicity, hypokalemia and hypomagnesemia) occurred at similar rates in both groups. Early addition of empirical dAMB in febrile neutropenic patients leads to their early defervescence and decreased dose requirement.

Author List

Malhotra P, Makkar A, Guru Murthy GS, Varma N, Varma S, Chakrabarti A

Author

Guru Subramanian Guru Murthy MD Assistant Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Amphotericin B
Antifungal Agents
Drug Therapy
Febrile Neutropenia
Female
Hematologic Neoplasms
Humans
Male
Time Factors
Treatment Outcome
Young Adult