Administration of amphotericin B in lipid emulsion decreases nephrotoxicity: a controlled study in critically ill patients

Objective

To evaluate the differences in administered in a lipid emulsion compared to amphotericin B (AmpoB) in dextrose 5%, for the treatment of Candida albicans infection.

Sixty consecutive critically ill patients with confirmed or suspected Candida infection received AmphoB (1 mg/kg/24 h) administered randomly in either dextrose 5% (group A) or in lipid emulsion (20% Intralipid^®) (group B).

Measurements and main results

Clinical tolerance (fever, chills, hemodynamics), liver function tests, electrolytes and coagulation profile were evaluated. Patients receiving AmphoB in lipid emulsion experienced a lower incidence of drug-associated fever (61.4% versus 5.8%, P < 0.003), rigors (54% versus 8.5%, P < 0.004), hypotension (17% versus 0%) and nephrotoxicity. Significant thrombocytopenia (264,500 ± 71,460/mm³ to 163,570 ± 34,450/mm³, P < 0.01), not associated with active bleeding, occurred with AmphoB-lipid emulsion but not with the dextrose regimen.

Conclusions

Treatment with AmphoB-lipid emulsion of critically ill patients with Candida infection seems to be safer and as effective as the conventional mode of administration.