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A Prospective and Retrospective Analysis of the Nephrotoxicity and Efficacy of Lipid‐Based Amphotericin B Formulations
Author(s) -
Can Joan P.,
Garey Kevin W.,
Danziger Larry H.
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.13.1107.34613
Subject(s) - nephrotoxicity , amphotericin b , medicine , neutropenia , amphotericin b deoxycholate , chemotherapy , mycosis , refractory (planetary science) , antibiotics , gastroenterology , surgery , pharmacology , toxicity , antifungal , caspofungin , microbiology and biotechnology , biology , dermatology , astrobiology
Study Objective. To determine the usage patterns of the lipid‐based amphotericin B formulations at our institution and to compare the observed nephrotoxicity and efficacy of these formulations. Design. Prospective and retrospective observational study. Setting. Urban 350‐bed teaching hospital. Patients. Sixty‐seven nonhemodialysis patients who were prescribed greater than 3 days of amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L‐AmB) from 1996–1999. Measurements and Results. Forty‐six patients received ABLC and 21 received L‐AmB. Oncology patients accounted for most prescriptions of both formulations. Amphotericin B lipid complex most frequently was prescribed for treatment of documented fungal infections (50%), followed by treatment of neutropenic fever (33%). Liposomal amphotericin B most frequently was prescribed for treatment of neutropenic fever (62%), followed by treatment of documented fungal infections (29%). Seventy‐eight percent of patients treated with ABLC and 90% of those who received L‐AmB were started on the lipid‐based formulation due to being refractory or intolerant to prior antifungal therapy. Two (4.4%) patients receiving ABLC and four (19%) patients receiving L‐AmB experienced nephrotoxicity at the end of therapy (NS). Of the patients with a documented fungal infection, 20 out of 23 (87%) of those treated with ABLC and 4 out of 5 (80%) of those treated with L‐AmB had a complete or partial response to therapy (NS). One patient with febrile neutropenia had a breakthrough fungal infection while receiving L‐AmB. Conclusion. No significant differences in nephrotoxicity or efficacy were found between ABLC and L‐AmB. Until further studies indicate clinically significant differences in nephrotoxicity between the two liposomal amphotericin B formulations, it is recommended that economics continue to be the major determinant for product selection.