JAC Advance Access published online on February 11, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg139
© 2003 by The British Society for Antimicrobial Chemotherapy
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original article
1 Clinical Pharmacokinetics
Unit, Medical Intensive Care Research Laboratory, Department of
Internal Medicine, University of Innsbruck, Anichstrasse 35, A-6020
Innsbruck; Intensive Care
Unit, Department of Internal Medicine, University of Innsbruck
* Corresponding author. E-mail: romuald.bellmann{at}uibk.ac.at.
Received 17 August 2002
; revised 4 November 2002
; accepted 6 January 2003
Objectives: The pharmacokinetics of
lipid-formulated amphotericin B (AMB), and of AMB that has dissociated
from its lipid moiety and bound to lipoproteins in plasma, were
separately determined in critically ill patients. Patients and methods: Eleven patients required
continuous veno-venous haemofiltration (CVVH). Five of them were
treated with liposomal AMB (AmBisome) and seven with AMB colloidal
dispersion (Amphocil). Six of the critically ill were not undergoing
CVVH (three of them treated with liposomal AMB and three with AMB
colloidal dispersion). Results: Significant amounts of AMB are liberated
from liposomes or colloidal dispersion during circulation in plasma,
where pharmacokinetics mimic that of AMB deoxycholate. Elimination
of the remaining lipid-formulated fraction is different and differentially
affected by CVVH. Plasma levels of lipid-formulated AMB were significantly
higher in patients treated with liposomal AMB than in those treated
with AMB colloidal dispersion; clearance of liposomal AMB is enhanced
by haemofiltration, whereas elimination of AMB colloidal dispersion
is not significantly affected. Conclusions: The pharmacokinetics of AMB that
has been liberated from its lipid moiety is similar under treatment
with either liposomal AMB or AMB colloidal dispersion. Since no
significant influence of haemofiltration on the pharmacokinetics
of liberated AMB has been found, a standard dose of lipid-formulated
AMB can be recommended for patients on haemofiltration.
Keywords: pharmacokinetics, amphotericin B deoxycholate,
liposomal amphotericin B, amphotericin B colloidal dispersion
Amphotericin B lipid formulations in critically
ill patients on continuous veno-venous haemofiltration
2 Clinical Pharmacokinetics
Unit, Medical Intensive Care Research Laboratory, Department of
Internal Medicine, University of Innsbruck, Anichstrasse 35, A-6020
Innsbruck
3 Intensive Care
Unit, Department of Internal Medicine, University of Innsbruck
4 Infectious Disease Unit, Division
of General Internal Medicine, Department of Internal Medicine, University
of Innsbruck, Austria
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. M. M. Y. Li, C. D. Gomersall, G. Choi, Q. Tian, G. M. Joynt, and J. Lipman A systematic review of antibiotic dosing regimens for septic patients receiving continuous renal replacement therapy: do current studies supply sufficient data? J. Antimicrob. Chemother., November 1, 2009; 64(5): 929 - 937. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kubin and A. Dzierba The Effects of Continuous Renal Replacement on Anti-infective Therapy in the Critically Ill Journal of Pharmacy Practice, April 1, 2005; 18(2): 109 - 117. [Abstract] [PDF]
|
|