Pharmacokinetics of amphotericin B after accidental overdose in an adult
critically ill patient treated with plasmapheresis: A case report
Abstract
Amphotericin B is a broad-spectrum antifungal agent that is used in the
treatment of systemic fungal infections. We describe the case of a
62-year-old female patient with recent aneurysmal subarachnoid
hemorrhage who was treated for suspected ventriculitis and a fungal
coinfection. Instead of liposomal amphotericin B (L-AmB), 465 mg (5
mg/kg) amphotericin B deoxycholate (DOC) was inadvertently administered,
leading to refractory shock with multiple organ failure and requiring
mechanical ventilation. Since an overdose of amphotericin B can lead to
fatal consequences and has a half-life of 15 days, plasmapheresis was
started. The serum concentration decreased from 1.32 µg/mL to 0.62 µg/mL
before plasmapheresis, demonstrating a mean half-life of 49 hours. After
two plasmapheresis sessions, the serum concentration further dropped to
0.26 µg/mL, demonstrating a mean half-life of 17 hours. In contrast, the
third plasmapheresis session had no effect on serum concentration. The
patient made a full recovery, potentially facilitated by enhanced
amphotericin B elimination through plasmapheresis. Positive outcomes
were previously reported in two adult patients treated with
plasmapheresis. However, other reports without plasmapheresis described
fatal outcomes in adult patients, albeit with a twofold overdose
compared to the two patients successfully treated with plasmapheresis.
Moreover, plasmapheresis itself carries risks such as hypocalcemia,
metabolic alkalosis, and coagulation deficits. Consequently, the role of
plasmapheresis in amphotericin B overdose is still debated.