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662 Amphotericin B for Neutropenie Feuer
receive amphotericin B, and 35 of these treatment courses were complicated
by neutropenic fever that required broad-spectrum antibacterial agents.
Median duration of neutropenia for all patients was 18 days (range, 9-80 days).
Patients who received amphotericin B had a median of 18 days (range, 10-80
days) of neutropenia compared to a median of 17 days (range, 9-32 days) in
those who did not receive this drug (P> .1, NS; Student's t test). In eight
patients, fungal blood cultures were positive. Three patients had fungemia
with Candida albicans, two had C. tropicalis, one had Torulopsis glabrata,
one had noncandidal yeast not further identified, and one had C. krusei and
Saccharomyces cereuisiae. Positive throat, stool, and urine cultures were
seen in 28, 32, and 9 patients, respectively.
Median duration of unexplained neutropenic fever before amphotericin
B administration was 5 days and ranged from 0 to 32 days. Median total dose
of amphotericin B was 460 mg (range, 10-2450 mg). Fifty-eight of 87
treatment courses (66.7%) were associated with fever resolution in a median
of 3 days (range, 1-18 days); this defervescence corresponded to an amphotericin
B dose of 135 mg (range, 10-900 mg). Of 15 patients with positive
fungal blood cultures, or the same fungus culture from at least two other
unrelated sites, 12 (80%) had resolution of their fever during amphotericin B
administration.
Adverse reactions to amphotericin B are listed in Table 2. Most patients
experienced rigors, which usually responded to meperidine. Only 24% of
patients developed fever that could be attributed to the amphotericin B.
Hypotension (systolic blood pressure < 90 mm Hg) was uncommon and
resolved in all cases by slowing the infusion rate and administering crystalloid
fluids. Bronchospasm was observed infrequently but was severe enough in
two patients to necessitate permanent discontinuation of the amphotericin B.
Forty-five of 87 treatment courses were associated with a significant rise in
creatinine, the median rise being 0.5 mg/dl (range, 0.0-2.6 mg/dl). By
comparison, similarly treated patients who received broad-spectrum antibacterial
drugs for neutropenic fever, but not amphotericin B, had a median
creatinine rise of 0.1 mg/dl, with a maximum value of 2.9 mg/dl. No patient
underwent hemodialysis for renal failure. Marked potassium and magnesium
Table 2. Amphotericin B Adverse Reactions
No. of Treatment Courses
% of Treatment
Reaction (n = 87) Courses
Rigors 78 90
Fever 21 24
Bronchospasm 8 9
Hypotension 8 9
Increased creatinine 45 52