Liposomal Amphotericin-B Infusion-related Reactions and Rate of Infusions: A Single Center Cohort Study

Objectives: Liposomal amphotericin B is a broad-spectrum antifungal treatment used for life-threatening infections, but it commonly induces infusion-related adverse events that may prevent treatment completion. Based on anecdotal evidence, a slow infusion guideline at treatment initiation has been suggested to reduce these reactions. This study aimed to determine if slowing down the infusion rate on treatment initiation would reduce the rate of infusion-related adverse events. 
Methods: A retrospective cohort study was conducted examining the primary outcome of adverse event rates between patients who received slow and standard (2-hour or faster) infusions at a major hospital in Australia. Secondary outcomes were risk factors associated with infusion reactions. The rates of adverse events were analyzed using Fisher’s exact test. 
Results: An 8-year audit identified 47 patients who were administered liposomal amphotericin-B. The average age of the study population was 61.7 years and 28 (59.6%) were male patients. Slower than standard infusions were given to 5 (10.6%) patients on treatment initiation. Infusion-related adverse events occurred in 2 (40.0%) patients with reduced rates and 5 (11.9%) patients with standard infusion rates (p=0.154). Typical reactions were myalgia, dyspnoea, and flushing. Four patients with adverse events had been rechallenged after further rate reductions and prophylactic medications with the completion of treatment. No risk factors for adverse events were identified among demographics, comorbidities, or co-prescribed medications. 
Conclusion: Slowing the infusion rate of liposomal amphotericin-B administration does not appear to reduce the likelihood of infusion-related reactions, however, it can be trialed for adverse-event management. J Microbiol Infect Dis 2022; 12(4): 148-153.