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.