A randomized prospective trial of amphotericin B lipid emulsion versus dextrose colloidal solution in critically ill...

Area of Science:

• Mycology
• Nephrology
• Critical Care Medicine

Background:

• Amphotericin B is a primary treatment for invasive fungal infections in critically ill patients.
• Nephrotoxicity occurs in over 50% of patients treated with amphotericin B, even with preventative measures.
• Newer amphotericin B formulations exist but have high costs and uncertain bioavailability in critically ill populations.

Purpose of the Study:

• To compare the nephrotoxicity of amphotericin B lipid emulsion versus amphotericin B dextrose in critically ill patients.
• To evaluate the safety and efficacy of different amphotericin B formulations in a high-risk patient group.

Main Methods:

• A randomized, prospective clinical trial was conducted.
• Patients received either amphotericin B dextrose (0.5 mg/kg/day) or amphotericin B lipid emulsion (1.0 mg/kg/day).
• Creatinine clearance was monitored weekly throughout treatment and for two weeks post-therapy.

Main Results:

• Both groups were comparable in baseline demographics and renal function.
• The amphotericin B lipid emulsion group experienced a significantly smaller decrease in creatinine clearance.
• This occurred despite the lipid emulsion group receiving a higher cumulative dose of amphotericin B.

Conclusions:

• Amphotericin B lipid emulsion demonstrates less nephrotoxicity compared to amphotericin B dextrose.
• Higher cumulative doses of amphotericin B can be safely administered using the lipid emulsion formulation.
• This suggests a potentially improved therapeutic option for invasive fungal infections in critically ill patients.