Amphotericin B toxicity reduced by administration in fat emulsion

Area of Science:

• Mycology
• Pharmacology
• Hematology

Background:

• Amphotericin B is a critical antifungal for neutropenic patients but causes significant toxicities.
• Infusion-related events and nephrotoxicity limit amphotericin B use.
• Novel administration methods are needed to improve tolerability and efficacy.

Observation:

• A patient with acute myelogenous leukemia experienced severe infusion-related reactions to conventional amphotericin B.
• Switching to amphotericin B prepared in a 20% fat emulsion resolved rigors, chills, and fever.
• The patient tolerated escalated doses, became afebrile, and showed improved renal function.

Findings:

• Administering amphotericin B in a fat emulsion significantly reduced infusion-related adverse events.
• This formulation approach appears to mitigate common toxicities associated with amphotericin B.
• The patient's clinical status improved, including resolution of fever and decreased serum creatinine.

Implications:

• Fat emulsion formulation of amphotericin B offers a promising strategy to manage infusion-related toxicities.
• Further clinical trials are essential to compare lipid formulations of amphotericin B for efficacy and safety.
• This approach could enhance the utility of amphotericin B in treating invasive fungal infections.