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Pharmacokinetics of liposomal amphotericin B in pleural fluid

Brad Moriyama1, Parizad Torabi-Parizi, Alexandra K Pratt

  • 1NIH Clinical Center Pharmacy Department, 10 Center Drive, Bethesda, MD 20892, USA. bmoriyama@cc.nih.gov

Antimicrobial Agents and Chemotherapy
|January 21, 2010
PubMed

Insights

This study measured liposomal amphotericin B levels in pleural fluid for a patient with pulmonary zygomycosis and empyema. Results show low drug penetration, suggesting chest tube drainage may be necessary for effective treatment.

Area of Science:

  • Mycology
  • Pharmacokinetics
  • Infectious Diseases

Background:

  • Pulmonary zygomycosis is a severe fungal infection.
  • Empyema complicates fungal pneumonia, requiring effective antifungal therapy.
  • Liposomal amphotericin B is a key antifungal agent.

Observation:

  • This case study investigated liposomal amphotericin B penetration into pleural fluid.
  • A patient with pulmonary zygomycosis and empyema was monitored.

Findings:

  • Pleural fluid concentrations of liposomal amphotericin B ranged from 2.12 to 4.91 microg/ml.
  • The area under the concentration-time curve ratio (AUC(pleural fluid)/AUC(serum)) was 9.4% over 24 hours.
  • This indicates limited penetration of liposomal amphotericin B into the pleural space.

Implications:

  • The low intrapleural drug levels suggest standard systemic therapy may be insufficient.
  • Adjunctive chest tube drainage should be considered for zygomycotic empyema.
  • Further research on optimizing antifungal delivery to the pleural space is warranted.

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