Administration of amphotericin B in lipid emulsion decreases nephrotoxicity: results of a prospective, randomized, controlled study in critically ill patients.
OBJECTIVE
To evaluate the differences in efficacy and in clinical and biochemical tolerance to amphotericin B administered in a lipid emulsion compared with amphotericin B administered in 5% dextrose in water in the treatment of Candida albicans infection in intensive care unit (ICU) patients.


METHODS
Prospective, controlled, randomized study, conducted during a 2.5-yr period, comparing the two treatment protocols.


METHODS
General ICU of a university-affiliated municipal hospital.


METHODS
Sixty consecutive critically ill patients with confirmed or suspected Candida infection.


METHODS
Patients received amphotericin B (1 mg/kg/24 hrs), administered randomly in 5% dextrose in water (group A), or in lipid emulsion (20% intralipid) (group B).


RESULTS
Clinical tolerance (fever, chills, hemodynamics), hepatorenal tolerance, and biological tolerance (serum electrolytes and coagulation profile) were evaluated. Patients receiving amphotericin B in lipid emulsion experienced a lower frequency rate of drug-associated fever (61.4% vs. 5.8%, p < .003) rigors (54% vs. 8.5%, p < .004), hypotension (17% vs. 0%), and nephrotoxicity (increase of serum creatinine concentration 66.7% vs. 20%, p < .0002). Significant (264,500 +/- 71,460 to 163,570 +/- 34,450 mm3, p < .01) thrombocytopenia, not associated with active bleeding, occurred in patients receiving amphotericin B lipid in emulsion but not in patients receiving the drug in dextrose.


CONCLUSIONS
Treatment with amphotericin B in a lipid emulsion when given to critically ill patients with Candida sepsis seems to be safer and as effective as the conventional mode of administration.
Sorkine
P
P
Department of Anesthesiology, Tel-Aviv Sourasky Medical Center, Israel.
Nagar
H
H
Weinbroum
A
A
Setton
A
A
Israitel
E
E
Scarlatt
A
A
Silbiger
A
A
Rudick
V
V
Kluger
Y
Y
Halpern
P
P
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects*; D002177:Candidiasis / Q000188:drug therapy*; D016638:Critical Illness; D005217:Fat Emulsions, Intravenous; D005260:Female; D005947:Glucose; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D012996:Solutions
D005217:Fat Emulsions, Intravenous; D012996:Solutions; D000666:Amphotericin B; D005947:Glucose