ARTICLE Retrospective Analysis of the Use of Lipid-Based Formulations of Amphotericin B in a Pediatric Hospital

Background: The use of antifungal agents has been increasing in the growing population of immunocompromised patients. To address the problem of renal and infusion-related toxic effects of conventional amphotericin B, several lipid-based formulations of this drug have been developed. At the authors ’ pediatric institution, recommendations for the use of these products were established in 2001. Objective: To evaluate the use of lipid-based formulations of amphotericin B and to make any necessary changes to the current recommendations. Methods: The charts of patients who received amphotericin B lipid complex or liposomal amphotericin B between April 2003 and July 2004 were reviewed. Practices in the use of lipid-based formulations of amphotericin B were compared with the recommendations. Results: Eighteen patients were identified for the chart review. The major reasons for prescribing lipid-based formulations of amphotericin B were current documented renal dysfunction or history of such dysfunction with conventional amphotericin B (9 patients) and serious infusion reactions (3 patients) with conventional amphotericin B. Liposomal amphotericin B was the most commonly prescribed initial therapy (13 patients), and all but one of the patients were eventually switched to this form of therapy. For 7 patients (39%), the reason for using either liposomal amphotericin B or amphotericin B lipid complex was consistent with the recommendations. In 8 cases (44%), amphotericin B lipid complex should have been used first, and in 3 cases there was no apparent reason for giving a lipid-based formulation of amphotericin B. Conclusions: Institutional recommendations for the use of lipid-based formulations of amphotericin B should be clearer and better enforced. They should specify that if amphotericin B is selected to treat a documented or suspected fungal infection, conventional amphotericin B should be given; that in patients with pre-existing impairment of renal function, a history of serious infusion reactions or renal impairment with conventional amphotericin B, and for those receiving concomitant nephrotoxic drugs or undergoing bone marrow transplantation