Comparison of Different Doses of Amphotericin B Intrathecal Injection Combined with Continuous Cerebrospinal Fluid Drainage Replacement in the Treatment of Cryptococcal Meningitis

Hua HE; Ying HUANG; Yan-ling ZHANG; Jun XU; Wen-ming LI; Yun LUO

doi:10.12259/j.issn.2095-610X.S20201230

Volume 41 Issue 12

Dec. 2019

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Article Navigation > Journal of Kunming Medical University > 2020 > 41(12): 112-118

Hua HE, Ying HUANG, Yan-ling ZHANG, Jun XU, Wen-ming LI, Yun LUO. Comparison of Different Doses of Amphotericin B Intrathecal Injection Combined with Continuous Cerebrospinal Fluid Drainage Replacement in the Treatment of Cryptococcal Meningitis[J]. Journal of Kunming Medical University, 2020, 41(12): 112-118. doi: 10.12259/j.issn.2095-610X.S20201230

Citation:

Hua HE, Ying HUANG, Yan-ling ZHANG, Jun XU, Wen-ming LI, Yun LUO. Comparison of Different Doses of Amphotericin B Intrathecal Injection Combined with Continuous Cerebrospinal Fluid Drainage Replacement in the Treatment of Cryptococcal Meningitis[J]. Journal of Kunming Medical University, 2020, 41(12): 112-118. doi: 10.12259/j.issn.2095-610X.S20201230

Citation:

Hua HE, Ying HUANG, Yan-ling ZHANG, Jun XU, Wen-ming LI, Yun LUO. Comparison of Different Doses of Amphotericin B Intrathecal Injection Combined with Continuous Cerebrospinal Fluid Drainage Replacement in the Treatment of Cryptococcal Meningitis[J]. Journal of Kunming Medical University, 2020, 41(12): 112-118. doi: 10.12259/j.issn.2095-610X.S20201230

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Comparison of Different Doses of Amphotericin B Intrathecal Injection Combined with Continuous Cerebrospinal Fluid Drainage Replacement in the Treatment of Cryptococcal Meningitis

doi: 10.12259/j.issn.2095-610X.S20201230

Dept. of Infectious Disease，The 3rd People’s Hospital of Kunming，Kunming Yunnan 650041，China

Received Date: 2020-04-25
Publish Date: 2020-12-25

Abstract

Abstract

Objective To investigate the efficacy and side effects of different doses of amphotericin B intrathecal injection in the treatment of cryptococcal meningitis. Methods 69 cases of cryptococcal meningitis admitted in the Third People's Hospital of Kunming city from January 2017 to December 2019, were enrolled in this study. In the induction period, continuous drainage through the lumbar cisterm was performed to replace cerebrospinal fluid on the basis of intravenous amphotericin B and oral fluorocytosine, and different doses of amphotericin B were injected intrathecally. All the cases were randomly divided into 4 groups, 17 cases in A0, A1, A2 group respectively, 18 cases in A3 group. Experimental groups were A1（amphotericin intrathecal injection B dose 0.2 mg）, A2（amphotericin intrathecal injection B dose 0.3 mg）and A3（amphotericin intrathecal injection B dose 0.5 mg）. A0 was control group（intravenous amphotericin B and oral fluorocytosine only, no intrathecal injection）. Clinical symptoms, cerebrospinal fluid biochemical indicators, pathogens in CSF, imaging, and adverse reactions were observed at 1, 2, and 4 weeks after treatment. Results The adverse reactions in group A1 were significantly lower than those in group A2 and A3（P < 0.001）; After 4 weeks of treatment, the positive rate of CSF ink staining in A2 and A3 groups was significantly lower than that in A1 group（ P < 0.05）; The positive rate of cerebrospinal fluid ink staining in A2 and A3 groups has no statistic significance（ P > 0.05）. MRI showed that the ratio of obvious absorption of lesions in Group A2 was significantly higher than that in group A1 and Group A3（ P < 0.05）; Comparison of the ratio of obvious absorption of lesions in A1 and A3 groups by MRI showed no statistically significant difference（ P > 0.05）. There were fewer adverse reactions in group A1, but the efficacy was not as good as that in group A2 and A3; The adverse reactions in group A2 were slightly higher than that in group A1 and lower than that in group A3, but A2 has the best efficacy. Due to the intolerance of some patients to adverse reactions, the patients in A3 group could not receive intrathecal injection every day. After treatment, the recovery of cerebrospinal fluid protein and sugar and the absorption of lesions in imaging examination were not as good as those in A2 group. Conclusion When using amphotericin B intrathecal injection in treatment of cryptococcal meningitis, if the dosage was increased quickly in order for rapid improvement, or long-term use of large dose of amphotericin B intrathecal injection, the adverse reactions instead of improvement would bring negative effect on subsequent treatment. Most patients can tolerate lower, moderate dosage of amphotericin B intrathecal injection.
- Different dosage,
- Amphotericin B,
- Intrathecal injection,
- Cryptococcal meningitis,
- Continuous spinal drainage and replacement

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References(17)

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