Vol.60 No.3 May 2012

Long-term monitoring of serum amphotericin B in a hemodialysis patient receiving a liposomal preparation for Cryptococcus infection

Taku Furukubo¹⁾, Naoki Tsuboniwa²⁾, Yoshikazu Katoh²⁾, Kana Matsumoto³⁾, Kunihiko Morita³⁾, Chiharu Matsunaga¹⁾, Chieko Maehara¹⁾, Satoshi Izumi¹⁾, Shigeichi Shoji²⁾ and Tomoyuki Yamakawa²⁾

¹⁾Hospital Pharmacy Service, Shirasagi Hospital, 7-11-23 Kumata, Higashisumiyoshi-ku, Osaka, Japan
²⁾Department of Medicine, Shirasagi Hospital
³⁾Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts

Abstract

Serum amphotericin B (AMPH-B) concentrations were measured in a hemodialysis (HD) patient during treatment of systemic Cryptococcus infection with liposomal amphotericin B (L-AMB). In a 69-year-old male HD patient, L-AMB was employed to treat Cryptococcus infection at a maintenance dose of 250 mg daily. The signs of infection improved after 8 months of L-AMB administration without the occurrence of any infusion reactions or drug-related adverse events. Pharmacokinetic analysis revealed that a steady state AMPH-B concentration was achieved within 13 days and the mean trough serum AMPH-B level was 55.3 mg/L(SD 8.0, n=12). A decline of the trough serum concentration of AMPH-B was not observed, even if L-AMB was infused during a hemodialysis session. Serum AMPH-B concentrations tended to decrease along with elevation of the serum CRP level. In this patient, high dose treatment with L-AMB was effective against Cryptococcus infection and well tolerated.

Key word

liposomal amphotericin B, PK-PD, hemodialysis, Cryptococcus infection

Received

January 30, 2012

Accepted

March 19, 2012

Jpn. J. Chemother. 60 (3): 342-346, 2012