Standardized electrolyte supplementation and fluid management improves survival during amphotericin therapy for cryptococcal meningitis in resource-limited settings

Open Forum Infectious Diseases
Nathan C BahrDavid R Boulware

Abstract

Amphotericin B is the preferred treatment for cryptococcal meningitis, but it has cumulative severe side effects, including nephrotoxicity, hypokalemia, and hypomagnesemia. Amphotericin-induced severe hypokalemia may predispose the patient to cardiac arrhythmias and death, and there is very little data available regarding these toxicities in resource-limited settings. We hypothesized that standardized electrolyte management during amphotericin therapy is essential to minimize toxicity and optimize survival in sub-Saharan Africa. Human immunodeficiency virus-infected, antiretroviral therapy naive adults with cryptococcal meningitis were prospectively enrolled at Mulago Hospital in Kampala, Uganda in 3 sequential cohorts with amphotericin B deoxycholate induction treatment. Intravenous fluid use was intermittent in 2001-2002, and universal in 2006-2012. In 2001-2009, serum potassium (K(+)) was monitored on days 1, 7, and 14 of treatment with replacement (K(+), Mg(2+)) per clinician discretion. In 2011-2012, K(+) was measured on days 1, 5, and approximately every 48 hours thereafter with universal electrolyte (K(+), Mg(2+)) supplementation and standardized replacement. Clinical outcomes were retrospectively compared between fluid ...Continue Reading

Associated Clinical Trials

References

Mar 1, 1990·Reviews of Infectious Diseases·H A GallisW W Pickard
Aug 26, 1998·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·M H WhiteC B Miller
Feb 2, 1999·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·J MayerJ Vorlìcek
Aug 21, 2001·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·C GirmeniaP Martino
Apr 16, 2002·AIDS·Neil FrenchCharles F Gilks
Apr 10, 2003·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alexander ImhofAndreas Schaffner
Sep 28, 1964·JAMA : the Journal of the American Medical Association·J A MCCHESNEY, J F MARQUARDT
Jun 8, 2007·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Tihana BicanicThomas Harrison
Aug 19, 2007·Tropical Medicine & International Health : TM & IH·Cheryl A LiechtyJonathan Mermin
Apr 25, 2008·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Andrew KambuguDavid R Boulware
Mar 14, 2009·Indian Journal of Cancer·A V BambaN A Kshirsagar
May 16, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Peter G PappasScott G Filler
Aug 14, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Barbara CastelnuovoAndrew Kambugu
Jan 6, 2010·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·John R PerfectTania C Sorrell
Mar 17, 2010·BMC Infectious Diseases·Joseph N JarvisThomas S Harrison
Jun 25, 2010·Tropical Medicine & International Health : TM & IH·Danielle B CohenFlorian Neuhann
Nov 15, 2011·The Journal of Infection·Conrad K MuzooraThomas S Harrison
Mar 8, 2013·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Kara N DurskiDavid R Boulware
Apr 5, 2013·The New England Journal of Medicine·Jeremy N DayJeremy J Farrar
Jun 26, 2014·The New England Journal of Medicine·David R BoulwareUNKNOWN COAT Trial Team

❮ Previous
Next ❯

Citations

Feb 22, 2016·Infectious Disease Clinics of North America·Eileen K Maziarz, John R Perfect
Dec 30, 2015·Diagnostic Microbiology and Infectious Disease·Joshua RheinUNKNOWN ASTRO-CM Team
Aug 19, 2015·Current Tropical Medicine Reports·Mahsa AbassiJoshua Rhein
Oct 19, 2016·Survey of Ophthalmology·Mohammed RigiAndrew G Lee
Jan 24, 2017·Expert Review of Anti-infective Therapy·Sarah LofgrenDavid R Boulware
Mar 16, 2017·The New England Journal of Medicine·David R Boulware, A Tariro Makadzange
Dec 3, 2016·AIDS Research and Therapy·Sirawat Srichatrapimuk, Somnuek Sungkanuparph
Jul 26, 2018·The Cochrane Database of Systematic Reviews·Mark W TenfordeNathan Ford
Jun 4, 2016·Current Clinical Microbiology Reports·Mark W TenfordeJoseph N Jarvis
Jul 23, 2020·Molecular Microbiology·Arianne Bermas, Jennifer Geddes-McAlister
Jul 29, 2017·Open Forum Infectious Diseases·Charlotte SchutzGraeme Meintjes
Jun 29, 2018·Internal and Emergency Medicine·Geoffrey CheminetJean-Benoît Arlet
Sep 4, 2015·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Reuben KiggunduUNKNOWN ASTRO-CM Team
Apr 20, 2021·The Lancet Infectious Diseases·Katharine Elizabeth StottWilliam Hope
May 22, 2021·Infectious Disease Clinics of North America·Alexis C GushikenJohn W Baddley
Jun 23, 2021·Expert Opinion on Pharmacotherapy·Marise BremerAngharad G Davis

❮ Previous
Next ❯

Clinical Trials Mentioned

ISRCTN45035509
NCT01075152

Software Mentioned

SPSS

Related Concepts

Related Feeds

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.