***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES --To compare the tolerance , efficacy , and pharmacokinetics of amphotericin deoxycholate ( Fungizone ) prepared in a parenteral fat emulsion ( Intralipid 20 % ) or glucose in HIV patients with c and idiasis . DESIGN --Non-blind r and omised controlled trial . SETTING --University hospital ; tertiary clinical care . PATIENTS --22 HIV positive patients with oral c and idiasis . INTERVENTIONS --Amphotericin 1 mg/kg/day given on four consecutive days as a one hour infusion dissolved in either 5 % glucose ( amphotericin-glucose ) or parenteral fat emulsion at a final concentration of 2 g/l fat emulsion ( amphotericin-fat emulsion ) . MAIN OUTCOME MEASURES -- Clinical tolerance ( fever , chills , sweats , nausea , arterial pressure , and pulse rate ) ; biological tolerance ( serum creatinine , electrolyte , and magnesium values ) ; clinical score of c and idiasis ; and serum concentrations of amphotericin .  RESULTS --11 patients were enrolled in each group . All the amphotericin-fat emulsion infusions were given without serious problem whereas four amphotericin-glucose infusions were stopped because of renal impairment ( n = 3 ) or severe chills ( n = 2 ) , or both . For patients completing the amphotericin-glucose treatment creatine concentration increased by 42 mumol/l ; four of seven patients had at least one creatinine value > or = 133 mumol/l versus one of 11 receiving amphotericin-fat emulsion .  Magnesium concentration fell significantly with amphotericin-glucose but not with amphotericin-fat emulsion .  Clinical side effects were noted in 36/38 infusions with amphotericin-glucose but 10/44 with amphotericin-fat emulsion .  Oral c and idiasis score was reduced similarly in both groups . Serum amphotericin concentrations were significantly lower and the volume of distribution of the drug higher after infusion of amphotericin-fat emulsion than after amphotericin-glucose . CONCLUSIONS -- Clinical and renal toxicity of amphotericin are reduced when the drug is prepared in fat emulsion . Preparation is simple and cost effective . Its efficacy is similar to that of conventional amphotericin ABSTRACT Amphotericin B deoxycholate ( AmBd ) is the recommended induction treatment for HIV-associated cryptococcal meningitis ( CM ) . Its use is hampered by toxicities that include electrolyte abnormalities , nephrotoxicity , and anemia . Protocol s to minimize toxicity are applied inconsistently . In a clinical trial cohort of AmBd-based CM induction treatment , a st and ardized protocol of preemptive hydration and electrolyte supplementation was applied . Changes in blood counts , electrolyte levels , and creatinine levels over 14 days were analyzed in relation to the AmBd dose , treatment duration ( short course of 5 to 7 days or st and ard course of 14 days ) , addition of flucytosine ( 5FC ) , and outcome . In the 368 patients studied , the hemoglobin levels dropped by a mean of 1.5 g/dl ( 95 % confidence interval [ CI ] , 1.0 to 1.9 g/dl ) following 7 days of AmBd and by a mean of 2.3 g/dl ( 95 % CI , 1.1 to 3.6 g/dl ) after 14 days . Serum creatinine levels increased by 37 μmol/liter ( 95 % CI , 30 to 45 μmol/liter ) by day 7 and by 49 μmol/liter ( 95 % CI , 35 to 64μmol/liter ) by day 14 of AmBd treatment . Overall , 33 % of patients developed grade III/IV anemia , 5.6 % developed grade III hypokalemia , 9.5 % had creatinine levels that exceeded 220 μmol , and 6 % discontinued AmBd prematurely . The addition of 5FC was associated with a slight increase in anemia but not neutropenia . Laboratory abnormalities stabilized or reversed during the second week in patients on short-course induction . Grade III/IV anemia ( adjusted odds ratio [ aOR ] , 2.2 ; 95 % CI , 1.1 to 4.3 ; P = 0.028 ) and nephrotoxicity ( aOR , 4.5 ; 95 % CI , 1.8 to 11 ; P = 0.001 ) were risk factors for 10-week mortality . In summary , routine intravenous saline hydration and preemptive electrolyte replacement during AmBd-based induction regimens for HIV-associated CM minimized the incidence of hypokalemia and nephrotoxicity . Anemia remained a concerning adverse effect . The addition of flucytosine was not associated with increased neutropenia .  Shorter AmBd courses were less toxic , with rapid reversibility ABSTRACT A multicentric r and omized trial was undertaken to compare the toxicity of amphotericin B in 5 % dextrose with that of amphotericin B in a fat emulsion ( Intralipid ) in cancer patients . Group 1 ( n = 33 ) received amphotericin B diluted in 5 % dextrose with premedication consisting of promethazine plus an antipyretic .  Group 2 ( n = 28 ) received amphotericin B diluted in 20 % Intralipid without premedication . Amphotericin B was infused daily at a dose of 1 mg/kg of body weight over a 1-h period to members of both groups for empirical antifungal therapy ( in neutropenic patients ) or for the treatment of documented fungal infections . The majority of patients ( 80 % ) received empirical amphotericin B treatment . The two groups were comparable with regard to age , gender , underlying disease , and the following baseline characteristics : use of other nephrotoxic drugs and serum levels of potassium and creatinine . The median cumulative doses of amphotericin B were 240 mg in group 1 and 245 mg in group 2 ( P = 0.73 ) . Acute adverse events occurred in 88 % of patients in group 1 and in 71 % of those in group 2 ( P = 0.11 ) . Forty percent of the infusions in group 1 were associated with fever , compared to 23 % in group 2 ( P < 0.0001 ) . In addition , patients in group 2 required less meperidine for the control of acute adverse events ( P = 0.008 ) , and fewer members of this group presented with hypokalemia ( P = 0.004 ) or rigors ( P < 0.0001 ) . There was no difference in the proportions of patients with nephrotoxicity ( P = 0.44 ) . The success rates of empirical antifungal treatment were similar in the two groups ( P = 0.9 ) . Amphotericin B diluted in a lipid emulsion seems to be associated with a smaller number of acute adverse events and fewer cases of hypokalemia than amphotericin B diluted in 5 % dextrose In this double-blind study to compare safety of 2 lipid formulations of amphotericin B , neutropenic patients with unresolved fever after 3 days of antibacterial therapy were r and omized ( 1:1:1 ) to receive amphotericin B lipid complex ( ABLC ) at a dose of 5 mg/kg/d ( n=78 ) , liposomal amphotericin B ( L Amph ) at a dose of 3 mg/kg/d ( n=85 ) , or L Amph at a dose of 5 mg/kg/d ( n=81 ) . L Amph ( 3 mg/kg/d and 5 mg/kg/d ) had lower rates of fever ( 23.5 % and 19.8 % vs. 57.7 % on day 1 ; P<.001 ) , chills/rigors ( 18.8 % and 23.5 % vs. 79.5 % on day 1 ; P<.001 ) , nephrotoxicity ( 14.1 % and 14.8 % vs. 42.3 % ; P<.01 ) , and toxicity-related discontinuations of therapy ( 12.9 % and 12.3 % vs. 32.1 % ; P=.004 ) . After day 1 , infusional reactions were less frequent with ABLC , but chills/rigors were still higher ( 21.0 % and 24.3 % vs. 50.7 % ; P<.001 ) . Therapeutic success was similar in all 3 groups ABSTRACT In a prospect i ve , r and omized clinical trial , the toxicity of 1 mg of amphotericin B ( AmB ) per kg of body weight per day infused in 5 % dextrose was compared with that of AmB infused in lipid emulsion in children with malignant disease . In an analysis of 82 children who received a full course of 6 days or more of AmB ( 117 courses ) , it was shown that there were significant increases in plasma urea and creatinine concentrations and in potassium requirement after 6 days of therapy with both AmB infused in dextrose and AmB infused in lipid emulsion , with there being no difference between the two methods of AmB administration . An intent-to-treat comparison of the numbers of courses affected by acute toxicity ( fever , rigors ) and chronic toxicity ( nephrotoxicity ) also indicated that there was no significant difference between AmB infused in dextrose ( 78 courses ) and AmB infused in lipid emulsion ( 84 courses ) . The pharmacokinetics of AmB  were investigated in 20 children who received AmB in dextrose and 15 children who received AmB in lipid emulsion .  Blood sample s were collected up to 24 h after administration of the first dose , and the concentration of AmB in plasma was analyzed by a high-performance liquid chromatography assay . The clearance ( CL ) of AmB in dextrose ( 0.039 ± 0.016 liter · h−1 · kg−1 ) was significantly lower ( P < 0.005 ) than the CL of AmB in lipid emulsion ( 0.062 ± 0.024 liter · h−1 · kg−1 ) . The steady-state volume of distribution for AmB in dextrose ( 0.83 ± 0.33 liter · kg−1 ) was also significantly lower ( P < 0.005 ) than that for AmB in lipid emulsion ( 1.47 ± 0.77 liter · kg−1 ) . Although AmB in lipid emulsion is apparently cleared faster and distributes more widely than AmB in dextrose , this study did not reveal any significant advantage with respect to safety and tolerance in the administration of AmB in lipid emulsion compared to its administration in dextrose in children with malignant disease The study objective was to obtain preliminary information regarding the safety and efficacy of amphotericin B ( AmB ) lipid complex ( ABLC ) in the treatment of AIDS-associated cryptococcal meningitis . Of 55 patients r and omly assigned to 6 weeks of therapy with ABLC  ( 1.2 - 5.0 mg/[kg.d ] , with ascending doses for three sequential cohorts ) or AmB ( 0.7 - 1.2 mg/[kg.d ] ) , 46 received > or = 12 doses . Transfusion requirements , mean decreases in hemoglobin level , and mean increases in creatinine level were significantly greater with AmB than with ABLC . The total number of adverse events , infusion-related events , and occurrences of hypomagnesemia and hypokalemia associated with each form of therapy were similar . Among 21 recipients of ABLC at a dosage of 5 mg/kg ( daily for 2 weeks and then thrice weekly for 4 weeks ) , symptoms and signs resolved for 18 ( 86 % ) . Of those receiving > or = 12 doses of ABLC , cultures converted to negative for 8 ( 42 % ) , were undeterminable for 3 ( 16 % ) , and remained positive for 8 ( 42 % ) despite resolution of symptoms . Although preliminary , these data suggest ABLC has significant activity in patients with AIDS-associated cryptococcal meningitis . Because this formulation has less hematologic and renal toxicity than does AmB , further evaluation of ABLC is warranted BACKGROUND . It is generally acknowledged that amphotericin B is the most effective treatment for cryptococcal meningitis . However , administration of this drug is accompanied by substantial adverse effects . This double-blind study , performed before the routine availability of highly active antiretroviral therapy , was design ed to compare the efficacy and safety of liposomal amphotericin B to conventional amphotericin deoxycholate in patients with acquired immunodeficiency syndrome ( AIDS ) and acute cryptococcal meningitis . METHODS . Patients were r and omized ( ratio , 1:1:1 ) from multiple sites in the United States and Canada to receive either amphotericin B at 0.7 mg/kg/day ( n = 87 ) , liposomal amphotericin B at 3 mg/kg/day ( n = 86 ) , or liposomal amphoteric 
    Output:
    
No significant differences among drugs were observed for cure or death .
All lipid-based formulations were safer than conventional AB for nephrotoxicity .
AB-Intralipid was more tolerable than conventional AB and caused less chills than ABCD .
AB-Intralipid was the best therapy ( > 60 % ) regarding nephrotoxicity , fever , chills and discontinuation .
Conventional AB was secondary to all lipid-based formulations .
Amphotericin B-Intralipid was identified as safer , cost-saving treatment in comparison with other formulations