Amphotericin B deoxycholate causes nephrotoxicity. Which newer formulation MOST significantly reduces nephrotoxicity while maintaining antifungal efficacy?

• A Liposomal amphotericin B (L-AmB) ✓
• B Amphotericin B lipid complex (ABLC)
• C Amphotericin B colloidal dispersion (ABCD)
• D Micellar amphotericin B with sodium deoxycholate (conventional)

Explanation

Among lipid-based formulations of amphotericin B, liposomal amphotericin B (L-AmB, AmBisome) has the highest unilamellar lipid encapsulation and the smallest particle size (~100 nm), which most efficiently delivers drug to the reticuloendothelial system and fungal cell membranes while minimizing concentration in renal tubular cells. L-AmB causes the least nephrotoxicity compared to ABLC and ABCD. ABCD (Amphotec) has higher rates of infusion-related reactions due to cholesterol sulfate coating. ABLC (Abelcet) is effective but has intermediate nephrotoxicity. All lipid formulations reduce but do not eliminate nephrotoxicity compared to conventional deoxycholate formulation.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.