A prospective and retrospective analysis of the nephrotoxicity and efficacy of lipid-based amphotericin B formulations.
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.


METHODS
Prospective and retrospective observational study


METHODS
Urban 350-bed teaching hospital.


METHODS
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.


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.


CONCLUSIONS
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.
Cannon
J P
JP
Department of Parmacy, Hines Veteran Affaires Hospital, Illinois, USA.
Garey
K W
KW
Danziger
L H
LH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004337:Drug Carriers; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000473:pathology; D008055:Lipids; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D011446:Prospective Studies; D012189:Retrospective Studies
D000935:Antifungal Agents; D004337:Drug Carriers; D008055:Lipids; D008081:Liposomes; D000666:Amphotericin B