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Published on: March 3, 2020
Liposomal amphotericin B-the present
J Maertens1,2, L Pagano3, E Azoulay4
1Department of Hematology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
Abstract:
Most invasive fungal infections are opportunistic in nature but the epidemiology is constantly changing, with new risk groups being identified. Neutropenia is a classical risk factor for fungal infections, while critically ill patients in the ICU are now increasingly at risk of yeast and mould infections. Factors to be considered when choosing antifungal treatment include the emergence of rarer fungal pathogens, the risk of resistance to azoles and echinocandins and the possibility of drug-drug interactions. Liposomal amphotericin B has retained its place in the therapeutic armamentarium based on its clinical profile: a broad spectrum of antifungal activity with a low risk of resistance, predictable pharmacokinetics with a rapid accumulation at the infection site (including biofilms), a low potential for drug-drug interactions and a low risk of acute and chronic treatment-limiting toxicities versus other formulations of amphotericin B. It is a suitable choice for the first-line empirical or pre-emptive treatment of suspected fungal infections in neutropenic haematology patients and is an excellent alternative for patients with documented fungal disease who can no longer tolerate or continue their first-line azole or echinocandin therapy, both in the haematology setting and in the ICU. Moreover, it is the first-line drug of choice for the treatment of invasive mucormycosis. Finally, liposomal amphotericin B is one of the few antifungal agents approved for use in children of all ages over 1 month and is included in paediatric-specific guidelines for the management of fungal disease.
Insights
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.
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.
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