Amphotericin B is widely used for severe life threatening
fungal infections. Its use is limited by a dose-dependent nephrotoxicity manifested by a reduction in glomerular filtration rate and tubular dysfunction. An elevated
creatinine associated with
amphotericin B is not only a marker for renal dysfunction but is also linked to a substantial risk for the use of
hemodialysis and a higher mortality rate; therefore
amphotericin B nephrotoxicity is not a benign complication and its prevention is essential. Several manipulations have been proposed to try and minimize
amphotericin B induced nephrotoxicity. Systematic hydration is crucial to minimize
amphotericin B.
Mannitol or intralipids administration were once suggested as protective based on anecdotal observational reports. Small prospective and randomized trials, however did not support a protective effect. Three new formulations have been developed in an attempts to improse both efficacy and tolerability:
amphotericin B in
lipid complex (ABLC,
Abelcet). Colloidal dispersion (ABCD, Amphotec and
amphotericin B liposome (
Ambisome). Three prospectives randomized studies have clearly shown that
Ambisome is less nephrotoxic than
amphotericin B. Unfortunately the only randomized trial comparing
Abelcet with
amphotericin B is an open-label treatment of
invasive candidiasis which was presented 5 years ago but never published as a full paper. Furthermore in a recent multicenter double-blind study it has been shown that
Ambisome has a better safety profile than
Abelcet with less
chills/rigors and less nephrotocixity.