Dosing implications for liposomal amphotericin B in pregnancy

Area of Science:

• Pharmacology
• Infectious Diseases
• Maternal-Fetal Medicine

Background:

• Liposomal amphotericin B (LAmB) is a crucial treatment for opportunistic infections like leishmaniasis, especially in pregnant individuals due to its safety profile.
• Optimal dosing strategies for LAmB in pregnancy remain unclear, posing challenges for effective treatment.
• Mucocutaneous leishmaniasis (MCL) in pregnancy requires careful management to ensure both maternal health and fetal well-being.

Approach:

• This study details a specific LAmB dosing regimen for a pregnant patient with MCL: 5 mg/kg/day (ideal body weight) for 7 days, followed by 4 mg/kg weekly (adjusted body weight).
• A comprehensive literature review was conducted to identify existing LAmB dosing strategies in pregnancy, focusing on the determination of dosing weight.
• Analysis included 143 cases from 17 studies, highlighting a significant gap in reported dosing weights and guideline recommendations.

Key Points:

• Only one prior study reported using ideal body weight for LAmB dosing in pregnancy.
• Current Infectious Diseases Society of America guidelines do not provide specific recommendations on dosing weight for amphotericin B in pregnancy.
• The described approach utilized ideal body weight for initial LAmB dosing, aiming to balance fetal safety and therapeutic efficacy.

Conclusions:

• The use of ideal body weight for LAmB dosing in pregnant patients with MCL is presented as a potentially safer alternative to total body weight.
• This strategy may mitigate risks to the fetus while maintaining the efficacy of LAmB for treating MCL during pregnancy.
• Further research is needed to establish definitive LAmB dosing guidelines for pregnant populations.