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Practice guidelines for lipid-based amphotericin B in stem cell transplant recipients
R E Quilitz1, A D Arnold, G R Briones
1Department of Pharmacy, H Lee Moffit Cancer Center, Tampa, FL 33612-9497, USA. quilitz@moffitt.usf.edu
This study provides practical guidelines for using lipid-based amphotericin B (AmB) in stem cell transplantation (SCT) patients to manage invasive fungal infections and neutropenic fever, offering a less nephrotoxic alternative.
Area of Science:
- Hematology
- Infectious Diseases
- Pharmacology
Background:
- Stem cell transplantation (SCT) patients face high morbidity and mortality from invasive fungal infections (IFIs).
- Conventional amphotericin B (AmB) treatment for IFIs is limited by nephrotoxicity.
- Lipid-based AmB formulations offer a less nephrotoxic alternative with comparable efficacy.
Framework:
- Consensus meeting of clinicians experienced in SCT infectious complications.
- MEDLINE search (1980-1999) and secondary sources for relevant primary articles.
- Evaluation of all identified articles for inclusion in the review.
Implementation:
- Guidelines focus on SCT patients with documented/probable IFIs, neutropenic fever, or requiring secondary fungal prophylaxis.
- Lipid-based AmB formulations provide adequate drug delivery with reduced nephrotoxicity.
- Careful patient selection is crucial due to the higher cost of lipid-based AmB.
Implications:
- Improved management of invasive fungal infections in immunocompromised SCT patients.
- Reduced nephrotoxicity and enhanced treatment outcomes in SCT recipients.
- Evidence-based recommendations for optimizing lipid-based AmB use in SCT settings.
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