Introduction
Amphotericin B is a broad-spectrum antifungal agent that is used in the treatment of systemic fungal infections [1]. It exerts its effect by disrupting the fungal cell wall synthesis by binding to ergosterol on cytoplasmic membranes [1]. Amphotericin B is considered highly toxic via several mechanisms. First, Amphotericin B can exert a direct cytotoxic effect by interacting with cholesterol in human cell membranes, leading to increased cell permeability and consequently cell death. Second, Amphotericin B infusion promotes proinflammatory cytokine release [2]. Adverse effects are dose-dependent and include fever, hemolysis, thrombocytopenia, renal failure, electrolyte disorders, hepatic failure, cardiac dysrhythmias, seizures and anaphylactoid shock [1]. Attempts have been made to improve tolerability and increase efficacy, such as binding amphotericin B to carriers. There are several carrier agents, including a non-lipid formulation with sodium deoxycholate (DOC) (recommended therapeutic dose 0.25-1 mg/kg/day) and lipid formulations, including amphotericin B lipid complex (ABLC) (3-5 mg/kg/day), liposomal amphotericin B (L-AmB) (3-5 mg/kg/day) and amphotericin B colloidal dispersion (ABCD) (4 mg/kg/day). Due to the significant differences in safety and dosing between the formulations, medication errors can have serious consequences for patients. In adult patients, four case reports have been documented where the non-lipid formulation was erroneously administered instead of the intended liposomal formulation [3-6]. Among these cases, only two report non-lethal outcomes in patients treated with plasmapheresis. However, these reports lack critical data on amphotericin B pharmacokinetics pre- and post-plasmapheresis [5,6]. We present data of amphotericin B pharmacokinetics after an accidental overdose with non-lipid amphotericin DOC 5 mg/kg instead of L-AmB 5 mg/kg in a critically ill patient. Furthermore, we report information on serum levels of amphotericin B before and after plasmapheresis, adding to the body of evidence with regard to the pharmacokinetics of amphotericin B.