Fungal infections, invasive liposomal amphotericin

Tollemar J, Hockerstedt K, Ericzon BG, Jalanko H, Ringden O. Liposomal amphotericin-B prevents invasive fungal, infections in liver-transplant recipients—a randomized, placebo-controlled study. Transplantation 1995 59 45-50. 

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. 

The safety and efficacy of liposomal amphotericin in 40 preterm and 4 full-term neonates with invasive yeast infections have been studied retrospectively (134). The initial dosage was 1 mg/kg/day, and was increased stepwise by 1 mg/kg to a maximum of 5 mg/kg, depending on the clinical condition. There were no infusion-associated reactions. Blood pressure, hepatic, renal, and hematological indices were not altered. Hypokalemia was noted in 16 infants but was always transient and responsive to potassium supplementation. Treatment with liposomal amphotericin was successful in 72% of the children. However, 12 of the 40 preterm infants succumbed to the fungal infection all had a birth weight of less than 1.5 kg. 

Leenders AC, Daenen S, Jansen RL, Hop WC, Lowenberg B, Wijermans PW, Cornehssen J, Herbrecht R, van der Lelie H, Hoogsteden HC, Verbrugh HA, de Marie S. Liposomal amphotericin B compared with amphotericin B deoxycholate in the treatment of documented and suspected neutropenia-associated invasive fungal infections. Br J Haematol 1998 103(1) 205-12. 

Ringden 0, Meunier F, Tollemar J, Ricci P, Tura S, Kuse E. Efficacy of amphotericin B encapsulated in liposomes (AmBisome) in the treatment of invasive fungal infections in immunocompromised patients. J Antimicrob Chemother 1991 28 73-82. 

Tollemar, J. et al, 1993. Randomized double-blind smdy of liposomal amphotericin B (Ambisome) prophylaxis of invasive fungal infections in bone marrow transplant recipients. Bone Marrow Transplant, 12(6), 577-582. 

M. H. Miceli and P. Chandrasekar, Safety and efficacy of liposomal amphotericin B for the empirical therapy of invasive fungal infections in immunocompromised patients. Infect. Drug Resist., 2012, 5, 9 16. 

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