Liposomal Amphotericin B: A Review of its use in the Treatment of Invasive Fungal Infections

2010 ◽  
Vol 2 ◽  
pp. 313-329
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B

scholarly journals Outpatient parenteral antifungal therapy (OPAT) for invasive fungal infections with intermittent dosing of liposomal amphotericin B

2020 ◽  
Vol 58 (7) ◽  
pp. 874-880
Author(s):  
Robert J van de Peppel ◽  
Alexander Schauwvlieghe ◽  
Ruth Van Daele ◽  
Isabel Spriet ◽  
Jan W van't Wout ◽  
...  
Keyword(s):  
The Netherlands ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Initial Response ◽  
Invasive Fungal Infections ◽  
Response To Treatment ◽  
Liposomal Amphotericin B

Abstract Triazole resistant A. fumigatus has been documented in many parts of the world. In the Netherlands, incidence is now above 10% and results in the need for long-term parenteral therapy with liposomal amphotericin B (LAmB). The long terminal half-life of LAmB suggests that intermittent dosing could be effective, making the application of outpatient antifungal therapy (OPAT) possible. Here, we report our experience with the use of OPAT for Invasive Fungal Infections (IFI). All adult patients treated with LAmB with a 2 or 3 times weekly administration via the outpatient departments in four academic tertiary care centers in the Netherlands and Belgium since January 2010 were included in our analysis. Patient characteristics were collected, as well as information about diagnostics, therapy dose and duration, toxicity, treatment history and outcome of the IFI. In total, 18 patients were included. The most frequently used regimen (67%) was 5 mg/kg 3 times weekly. A partial response to the daily treatment prior to discharge was confirmed by CT-scan in 17 (94%) of patients. A favorable outcome was achieved in 13 (72%) patients. Decrease in renal function occurred in 10 (56%) cases but was reversible in all and was treatment limiting in one patient only. The 100-day mortality and 1-year mortality after initiation of OPAT were 0% and 6%, respectively. In a selected population, and after confirmation of initial response to treatment, our data support the use of OPAT with LAmB for treatment of IFI in an intermittent dosing regimen.

scholarly journals Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B

2020 ◽  
Vol 13 (5) ◽  
pp. e233072 ◽  
Author(s):  
Darius Armstrong-James ◽  
Mickey Koh ◽  
Marlies Ostermann ◽  
Paul Cockwell
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. The first was Aspergillus infection in a 63-year-old man with bleeding oesophageal varices related to advanced liver disease. The second was gastrointestinal mucormycosis in a 74-year-old man who developed a small bowel obstruction following an autologous stem cell transplant for mantle cell lymphoma. The third was a Fusarium infection in a 32-year-old woman on immunosuppression for a bilateral lung transplant for cystic fibrosis. In all three cases, liposomal amphotericin B was required for urgent management of the patient’s IFI. We discuss the rationale for treatment with a potentially nephrotoxic agent in this setting.

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