Clinical evidence,mechanism, importance and management
A retrospective study between 1985 and 1988 identified 101 patients with AIDS who had been given amphotericin B for various systemic mycoses. The patients were given amphotericin 0.6 to 0.8 mg/kg daily for 7 to 10 days,then a dose three times a week for about 9 weeks. Nine patients were concurrently treated for Pneumocystis carinii pneumonia, and of these 4 who had been given pentamidine parenterally developed acute and rapid reversible renal failure. In all 4 cases, renal function returned to normal when drugs were withdrawn. No renal failure was seen in 2 others given pentamidine by inhalation or 3 given intravenous co-trimoxazole (See reference number 1).
Both amphotericin B and pentamidine are known to be nephrotoxic and renal impairment was attributed to additive effects of these drugs. The reason no toxicity occurred when pentamidine was given by inhalation is probably because serum levels achieved were low
In general,conventional amphotericin B should not be used with other nephrotoxic drugs such as parenteral pentamidine. Renal function should be monitored closely with either drug (daily in case of parenteral pentamidine), and it is essential that this recommendation is adhered to if both drugs are given. Anticipate likelihood of renal failure and need to withdraw drugs.
1. Antoniskis D,Larsen RA. Acute, rapidly progressive renal failure with simultaneous use ofamphotericin B and pentamidine. Antimicrob Agents Chemother (1990) 34, 470–2.