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Liposomal amphotericin B-the present.

J Maertens1,2, L Pagano3, E Azoulay4

  • 1Department of Hematology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.

The Journal of Antimicrobial Chemotherapy
|November 25, 2022
PubMed
Summary
This summary is machine-generated.

Liposomal amphotericin B is a versatile antifungal for invasive fungal infections, particularly in neutropenic patients and intensive care units. It offers broad-spectrum activity, low resistance risk, and favorable drug interaction profile.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections (IFIs) are opportunistic, with evolving epidemiology and new at-risk populations like intensive care unit (ICU) patients.
  • Emerging fungal pathogens, antifungal resistance (e.g., to azoles, echinocandins), and drug-drug interactions complicate treatment choices.

Purpose of the Study:

  • To review the clinical profile and therapeutic applications of liposomal amphotericin B (L-AmB) in managing invasive fungal infections.
  • To highlight L-AmB's suitability as a first-line or alternative antifungal therapy in specific patient groups.

Main Methods:

  • Literature review focusing on the clinical profile, pharmacokinetics, resistance patterns, and safety of liposomal amphotericin B.
  • Analysis of L-AmB's efficacy in neutropenic patients, ICU settings, and for specific infections like mucormycosis.

Main Results:

  • Liposomal amphotericin B demonstrates broad-spectrum antifungal activity with a low risk of resistance and predictable pharmacokinetics.
  • It exhibits rapid accumulation at infection sites, including biofilms, and has a low potential for drug-drug interactions and treatment-limiting toxicities.
  • L-AmB is effective for empirical/pre-emptive treatment in neutropenic patients, an alternative for those failing azole/echinocandin therapy, and first-line for mucormycosis.

Conclusions:

  • Liposomal amphotericin B remains a valuable therapeutic option due to its favorable clinical profile, broad activity, and safety.
  • It is recommended for specific high-risk patient populations, including children, and for treating invasive mucormycosis.