The utility of therapeutic plasma exchange for amphotericin B overdose

Area of Science:

• Pharmacology
• Nephrology
• Critical Care Medicine

Background:

• Medication errors represent a significant, preventable cause of patient harm in hospitals.
• Antifungal medications, like amphotericin B, are critical for treating serious infections but carry risks of toxicity.
• Cryptococcal meningitis requires prompt and accurate antifungal therapy.

Observation:

• A patient with cryptococcal meningitis experienced an acute overdose of amphotericin B deoxycholate.
• The overdose, a medication error, led to severe clinical manifestations including tremors, hypertension, visual hallucinations, vertigo, fever, and acute renal failure.
• The patient's condition necessitated immediate intervention.

Findings:

• A series of four therapeutic plasma exchange (TPE) treatments was administered emergently.
• TPE therapy resulted in the complete resolution of most of the patient's overdose-related symptoms.
• This case highlights the potential efficacy of TPE in managing severe amphotericin B toxicity.

Implications:

• Therapeutic plasma exchange may be a viable treatment option for severe amphotericin B overdose.
• This case underscores the importance of medication error prevention and management protocols in inpatient settings.
• Further research into TPE for drug-induced toxicities is warranted.