Retrospective study of the renal effects of amphotericin B lipid complex when used at higher-than-recommended dosages and longer durations compared with lower dosages and shorter durations in patients with systemic fungal infections

Study of Renal Safety in Amphotericin B Lipid Complex–Treated Patients

“…Similar to results of a previous report [25], multivariate logistic regression analysis in the present study indicated that doses above the 5 mg/kg/day recommended in the package insert were not associated with increased risk for renal impairment; however, the number of patients for whom higher doses were used was small, and a difference could have been missed. Likewise, age 118 years, duration of therapy 114 days, and underlying HSCT or hematologic malignancy were not found to be indicative of increased risk for renal dysfunction.…”

What is the current and future status of conventional amphotericin B?

“…Patients treated first-line with ABLC [6,7], L-AmB [8][9][10] and ABCD [11] have lower rates of nephrotoxicity compared to those treated with AmBd (Table 1). Moreover, the incidence and degree of reduced nephrotoxicities with lipid-formulated AmB are only weakly correlated with dosages [7,18,19]. Higher effective dosages of AmB can be given as lipid-formulated AmB compared with AmBd, with less risk of treatment-limiting renal dysfunction.…”

Current Options in Antifungal Pharmacotherapy

“…81 In general, higher rates of nephrotoxicity have not been observed when lipid formulations of amphotericin B are administered at higher than standard doses. 125,130,131 In a recent prospective clinical trial, however, the rate of nephrotoxicity was higher in patients who received L-AmB 10 mg/kg/day than in those who received L-AmB 3 mg/kg/day for the first 2 weeks of treatment for invasive mold infections. 60…”