Abstract

LIPOSOMAL AMPHOTERICIN B-REVIEW OF CLINICAL EXPERIENCE AND FUTURE DIRECTIONS

Dr. Payal Preet* and Dr. Anita K. Gupta

Abstract

Over the past two years, there has been a dramatic rise in the prescription of lipid formulations of amphotericin B at the hospitals. These compounds now account for a significant proportion of all expenditure on antimicrobial agents. Only one randomized controlled trial has assessed the efficacy of lipid formulations in treating proven fungal infections. Most of the available evidence on the use of lipid formulations is in the form of case series. There are therefore limited data to justify the widespread use of these compounds, and there are few circumstances when their administration is warranted. Therefore, local policies should be drawn up for the prescription of lipid formulations of amphotericin B, and, until more compelling data are available, that these drugs only be administered after discussion with microbiologists or infectious diseases physicians. Liposomal amphotericin B (LAmB) is a unique lipid formulation of amphotericin B. LAmB is a standard of care for a wide range of medically important opportunistic fungal pathogens. LAmB has a significantly improved toxicity profile compared with conventional amphotericin B deoxycholate (DAmB). Its long terminal half-life and retention in tissues suggest that single or intermittent dosing regimens are feasible, and these should be actively investigated in both preclinical models and in clinical trials. Significant gaps remain in knowledge of pharmacokinetics and pharmacodynamics in special populations such as neonates and children, pregnant women and obese patients.

Keywords: Liposomal amphotericin B, Amphotericin B deoxycholate, Lipid formulations of amphotericin B.