Rigors amphotericin

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

In another patient, serious adverse events (fever, severe rigors, a fall in blood pressure, worsening mental status, increasing creatinine concentration, and leukocjdosis) occurred after unrecognized substitution of one amphotericin formulation (ABLC) by another (ABCD) (132). After discovery of the switch, ABLC therapy was rein-stituted and tolerated without incident. 

Data on the safety of amphotericin deoxycholate have been reported for 50 therapeutic courses in 44 children and adolescents with cancer and a median age of 6.8 years (range 9 months to 18 years) (50). Amphotericin deoxycholate was given in a dose of 1 mg/kg over 2 hours for a mean duration of 7.8 days. Most of the patients received the drug as empirical antifungal therapy in the setting of persistent fever and neutropenia. Nephrotoxicity, defined as a 100% increase in the serum creatinine from baseline, was observed in only one patient. Infusion-related reactions (fevers and/or rigors) occurred in 24% of treatment courses. Thus, amphotericin deoxycholate was relatively well tolerated in this population, although the mean duration of therapy was comparatively short. 

G Infusion-related toxicities secondary to amphotericin are common and may be prevented with premedication with diphenhydramine and acetaminophen. Meperidine is effective in halting rigors and muscle spasms. Thus, it is typically given in response to rigors, and not as premedication. Sodium loading with normal saline may prevent some of the renal toxicities, particularly prere-nal azotemia, associated with amphotericin and is administered prior to amphotericin. 

Rigors, or involuntary shivering, are a poorly understood but common post-operative complication. Shivering is also associated with fever seen in malignancy and amphotericin or granulocyte infusions. Numerous investigations have proven the... 

Management of adverse reactions Administration of amphotericin B lipid complex (ABLC) may be associated with infusion-related reactions, such as fever, rigors, and chills. Premedication with hydrocortisone may reduce the incidence of these reactions, but there are currently limited confirmatory data from clinical practice [7 ]. In a prospective 18-month study, patients with cancers were given intravenous hydrocortisone 100 mg 15-30 minutes before each infusion of ABLC (275 cycles mean dose per cycle 931 mg) [14. There were 44 infusion-related reactions (16%), most of which followed the first infusion of a cycle (15% subsequent infusions 2.9%). The most common reactions were rigors (15%) and fever (13). There was no significant difference in the rates or types of reactions between ABLC-naive and previously treated patients. The dose of ABLC had no effect on the rate of reactions, but female sex, neutropenia, and being younger were predictive. 

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