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Related Experiment Videos

Amphotericin B--not so terrible.

J Bishara1, M Weinberger, A Y Lin

  • 1Department of Internal Medicine C, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petach Tikva, Israel.

The Annals of Pharmacotherapy
|March 23, 2001
PubMed
Summary
This summary is machine-generated.

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A patient experienced severe reactions to liposomal amphotericin B and amphotericin B colloidal dispersion but tolerated amphotericin B deoxycholate. This case highlights that lipid formulations may not always be better tolerated than conventional amphotericin B.

Area of Science:

  • Mycology
  • Clinical Pharmacology
  • Patient Safety

Background:

  • Amphotericin B is a critical antifungal agent used for severe fungal infections.
  • Lipid formulations of amphotericin B (AmBisome, Amphocil) were developed to reduce toxicity, particularly nephrotoxicity.
  • Conventional amphotericin B deoxycholate (Fungizone) is associated with significant renal toxicity.

Observation:

  • A patient with acute myelomonocytic leukemia developed renal failure on amphotericin B deoxycholate.
  • The patient experienced immediate, severe anaphylactoid reactions to both liposomal amphotericin B and amphotericin B colloidal dispersion.
  • These reactions included dyspnea, chest pain, hypotension, fever, and chills.

Findings:

  • The patient tolerated subsequent treatment with amphotericin B deoxycholate, despite its known nephrotoxicity.

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  • This case contrasts with typical findings where switching between lipid formulations is usually well-tolerated.
  • It suggests a potential idiosyncratic hypersensitivity to lipid-based amphotericin B preparations in certain individuals.

    • Implications:

    • Clinicians should be aware that lipid formulations of amphotericin B can cause severe hypersensitivity reactions.
    • In rare cases, conventional amphotericin B deoxycholate may be a more tolerable option than lipid formulations.
    • This case underscores the importance of individualized patient assessment and careful monitoring during antifungal therapy.