Amphotericin B colloidal

ABLC = Amphotericin B Lipid Complex ABCD = Amphotericin B Colloidal Dispersion L-AMB = Liposomal Amphotericin B... 

Lipid-associated formulations of amphotericin B, liposomal amphotericin B (AmBisome) and amphotericin B lipid complex (Abelcet) have been approved for use in proven cases of candidiasis however, patients with invasive candidiasis have also been treated successfully with amphotericin B colloid dispersion (Amphotec or Amphocil). The lipid-associated formulations are less toxic but as effective as amphotericin B deoxycholate. 

Candida albicans, C. tropicalis, C parapsilosis and resolution of signs and symptoms of infection Remove existing central venous catheters when feasible, plus Amphotericin B IV 0.6 mg/k day or Fluconazole IV/po 6 mg/kg/day or An echinocandin or Amphotericin B IV 0.7 mg/kg/day plus fluconazole IV/po 800 mg/day Patients intolerant or refractory to other therapf Amphotericin B lipid complex IV 5 m k day Liposomal amphotericin B IV 3-5 mg/kg/day Amphotericin B colloid dispersion IV 2-6 mg/k day (continued)... 

Having a broad-spectrum fungicidal activity, amphotericin remains the mainstay of treatment of most invasive fungal infections. Compared with conventional amphotericin B deoxycholate, other lipid formulations of amphotericin (amphotericin B colloidal dispersion, amphotericin B lipid complex, and liposomal amphotericin B) facilitate treatment in patients with suspected and proven invasive mycoses, who are intolerant of or refractory to conventional amphotericin. 

Amphotericin deoxycholate versus amphotericin B colloidal dispersion... 

Amphotericin B colloidal dispersion During ABCD therapy 8.5% of patients developed nephrotoxicity compared with 21 % in those given amphotericin deoxycholate (5). 

Noskin GA, Pietrelli L, Coffey G, Gurwith M, Liang LJ. Amphotericin B colloidal dispersion for treatment of can-didemia in immunocompromised patients. Clin Infect Dis 1998 26(2) 461-7. 

Anaissie EJ, Mattiuzzi GN, Miller CB, Noskin GA, Gurwith MJ, Mamelok RD, Pietrelli LA. Treatment of invasive fungal infections in renally impaired patients with amphotericin B colloidal dispersion. Antimicrob Agents Chemother 1998 42(3) 606-11. 

Herbrecht R, Letscher V, Andres E, Cavalier A. Safety and efficacy of amphotericin B colloidal dispersion. An overview. Chemotherapy 1999 45(Suppl l) 67-76. 

Noskin G, PietreUi L, Gurwith M, Bowden R. Treatment of invasive fungal infections with amphotericin B colloidal dispersion in bone marrow transplant recipients. Bone Marrow Transplant 1999 23(7) 697-703. 

Anaissie EJ, GraybiU JR, Noskin GA, Oppenheim BA, Andres E, PietreUi LA. Treatment of 21 cases of invasive mucormycosis with amphotericin B colloidal dispersion. Eur J Clin Microbiol Infect Dis... 

Bowden R, Chandrasekar P, White MH, Li X, Pietrehi L, Gurwith M, van Bnrik JA, Laverdiere M, Safrin S, Wingard JR. A donble-blind, randomized, controhed trial of amphotericin B colloidal dispersion versns amphotericin B for treatment of invasive aspergillosis in immnnocom-promised patients. Chn Infect Dis 2002 35(4) 359-66. 

Clemons KV, Stevens DA. Comparative efficacy of amphotericin B colloidal dispersion and amphotericin B deoxycholate suspension in treatment of murine coccidioidomycosis. Antimicrob Agents Chemother 1991 35 1829-33. 

Hostetler JS, Clemons KV, Hanson LH, Stevens DA. Efficacy and safety of amphotericin B colloidal dispersion compared with those of amphotericin B deoxycholate suspension for treatment of disseminated murine cryptococcosis. Antimicrob Agents Chemother 1992 36 2656-60. 

DoubekM, Mayer J, Lauschova I, et ai. Comparison of the effect of amphotericin Bdesoxycholate and amphotericin B colloidal dispersion on renal functions and renal morphology in rats. Nephrology (Carlton) 2005 10 57-62. 

Krejcirova L, Lauschova I, Horky D, et ai. Influence of amphotericin B deoxycholate or amphotericin B colloidal dispersion on renal tubule epithelium in rat. Biomed Pap Med Eac Univ Palacky Olomouc Czech Repub 2004 148 221-3. 

White MH, Bowden RA, Sandler ES, et ai. Randomized, double-blind clinical trial of amphotericin B colloidal dispersion vs. amphotericin B in the empirical treatment of fever and neutropenia. Clin Infect Dis 1998 27 296-302. 

Sandler ES, Mustafa MM, Tkaczewski I, et al. Use of amphotericin B colloidal dispersion in children. J Pediatr Hematol Oncol 2000 22 242-6. 

Timmers GJ, Zweegman S, Simoons-Smit AM, et al. Amphotericin B colloidal dispersion (Amphocil) vs fluconazole for the prevention of fungal infections in neutropenic patients data of a prematurely stopped clinical trial. Bone Marrow Transplant 2000 25 879-84. 

ABCD amphotericin B colloidal dispersion ANCA anti-neutrophil cytoplasmic antibody... 

In patients intolerant to amphotericin B or fluconazole, one of the lipid formulations may he used. In a randomized trial, amphotericin B lipid complex (ABLC) was found to he equivalent to 0.6-1 mg/kg per day of amphotericin B, and open-lahel therapy with amphotericin B colloid dispersion (ABCD) has been successful. 

The use of deoxycholate amphotericin B frequently is associated with the development of induced nephrotoxicity. In an attempt to decrease the incidence of nephrotoxicity, three lipid formulations of amphotericin B have been developed and approved for use in humans amphotericin B lipid complex (ABLC, Abelcet Enzon Pharmaceuticals), amphotericin B colloidal dispersion (ABCD, Amphotec Inter-mune Pharmaceuticals), and liposomal amphotericin B (AmBisome Gilead Pharmaceuticals). In these preparations, amphotericin B is incorporated into the phospholipid bilayer membrane rather than in the enclosed aqueous phase. 

White MH, Anaissie EJ, Kusne S, et al. Amphotericin B colloidal dispersion vs amphotericin B as therapy for invasive aspergillosis. Clin Infect Dis 1997 24 635-642. 

Amphotericin B is complexed with deoxycholate (C-AMB) and marketed as a lyophilized powder (fungizone) containing 50 mg of amphotericin B that forms a colloid in water. Three lipid formulations of amphotericin B are marketed in the U.S. Amphotericin B colloidal dispersion (ABCD, AMPHOTEC, amphocil) contains equimolar amounts of amphotericin B and cholesteryl sulfate. AMBISOME is a small, unilamellar vesicle formulation that combines amphotericin B (50 mg) with 350 mg of lipid (phosphatidylcholine, cholesterol, and distearoylphosphatidylglycerol, in molar ratio of 10 5 4) in an -10% molar ratio. Amphotericin B lipid complex (ABLC, abelcet) contains dimyristoylphosphatidylcholine and dimyristoylphosphatidylglycerol in a 7 3 mixture with -35 mol% of amphotericin B. 

Fungizone Amphotericin B colloidal dispersion 10-50 mg in an infusion bag/bottle 500 mL... 

Currently, toxic effects of AmB have been largely ameliorated with the advent of lipid formulations, in these formulations, deoxycholate has been replaced by other Upids that mask AmB from susceptible tissues, thus reducing toxicity and facilitating its preferential uptake by reticuloendothelial cells. Thus, this drug delivery results in increasing efficacy and reduced toxicity. Three Upid-associated formulations of amphotericin are commercially available Uposomal amphotericin B (AmBisome), amphotericin B lipid complex (Abelcet), and amphotericin B colloidal dispersimi (Amphocil). These compoimds have been considered between the most striking advances in Leishmania therapy [52],... 

Observational studies In clinical trials, in the absence of premedication, the rates of infusion-related reactions have been higher with amphotericin B colloidal dispersion (ABCD) than with other forms of amphotericin B, including amphotericin B deoxy-cholate [7 ]. Data on pre-medication practices and infusion-related reactions in 170 patients (median age 37 years 52% men) who received 1230 infusions of ABCD (mean dose 2.8 mg/kg/day) have been captured in a multicenter, worldwide, observational registry [8 ]. Treatment was according to the site s standard treatment practice. Common pre-medications included glucocorticoids, antihistamines, paracetamol (acetaminophen), and metamizole. The overall rate of infusion-related reactions... 

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