In spite of the development of new antifungal drugs,
amphotericin B deoxycholate (d-AMB) remains the gold standard in the treatment of severe
fungal infections in immunosuppressed hosts. However, d-AMB is a toxic
drug, the most important dose-limiting toxicities being nephrotoxicity and infusion-related
allergic reactions.
Lipid and liposomal formulations of d-AMB have relatively lower toxicity and are considered alternative choices. However, the routine use of these formulations is limited by their higher cost. Using retrospective analysis, we explored the incidence of nephrotoxicity and
allergic reactions requiring the cessation of conventional d-AMB in 113 cases treated with the
drug. In contrast to knowledge in the relevant literature, we did not detect significant toxicity, which would have required discontinuation of the d-AMB treatment. Mean serum
creatinine levels were 0.72 +/- 0.25 and 0.84 +/- 0.31 mg dl(-1) before and after
therapy, respectively. Although the difference between
creatinine levels before and after d-AMB is statistically significant, the
creatinine level increased twofold in only eight cases. Mean serum
potassium levels were 3.8 +/- 0.54 and 3.6 +/- 0.7 mmol l(-1) before and after d-AMB respectively.
Potassium levels below 3 mmol l(-1) were found in 7 and 17 cases before and after d-AMB respectively.
Potassium levels were statistically lower in cases with fungal
mucositis. Severe infusion-related
allergic reactions were observed in three cases.
Antihistamine and
corticosteroid were added to the treatment in these cases. With these findings, we can conclude that d-AMB is a tolerable, low cost drug which can be safely used provided there is suitable
premedication and monitoring of blood
urea nitrogen, serum
potassium and
magnesium levels.