A randomized prospective trial of amphotericin B lipid emulsion versus dextrose colloidal solution in critically ill patients.
BACKGROUND
Amphotericin B is the agent of choice for most invasive fungal infections in critically ill patients. It is associated with at least a 50% incidence of nephrotoxicity, despite prophylactic measures such as sodium loading. Newer formulations of amphotericin B are available but are costly and have unknown bioavailability in critically ill patients. Previous trials in neutropenic and critically ill patients have demonstrated that mixing amphotericin B with 20% lipid solution (Intralipid; Clintec Nutrition, Deerfield, III) may decrease nephrotoxicity.


METHODS
In this randomized, prospective clinical trial, patients with positive fungal blood cultures, tracheal/sputum cultures or peritoneal cavity cultures were randomized to receive either 0.5 mg/kg per day of amphotericin B dextrose or 1.0 mg/kg per day of amphotericin B lipid emulsion. Duration of therapy was determined by the primary care team. Weekly 24-hour creatinine clearance was measured until 2 weeks after amphotericin B therapy was completed.


RESULTS
The two groups were similar based on age, white blood cell count, serum creatinine, and creatinine clearance at the beginning of therapy. The group receiving amphotericin B lipid emulsion had significantly less decrease in creatinine clearance compared with controls, despite receiving significantly more amphotericin B.


CONCLUSIONS
Amphotericin B lipid emulsion can be given at a higher total cumulative dose than amphotericin B dextrose with less nephrotoxicity.
Barquist
E
E
Department of Surgery, University of Miami School of Medicine, Florida, USA.
Fein
E
E
Shadick
D
D
Johnson
J
J
Clark
J
J
Shatz
D
D
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003102:Colloids; D003404:Creatinine / Q000097:blood; D005217:Fat Emulsions, Intravenous; D005947:Glucose; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D011446:Prospective Studies; D012996:Solutions
D000935:Antifungal Agents; D003102:Colloids; D005217:Fat Emulsions, Intravenous; D012996:Solutions; D000666:Amphotericin B; D003404:Creatinine; D005947:Glucose