Clinical Experience with Multilamellar Liposomal Amphotericin B in Patients with Proven and Suspected Fungal Infections

Abstract

Over a 3-year period, an unsonicated multilamellar vesicle preparation containing a low ratio of amphotericin B (5 mole %) was used as a routine alternative to amphotericin B-deoxycholate in treating 17 patients with a variety of systemic fungal infections representative of those commonly encountered on a tertiary care centre infectious disease service. Patient acceptability and convenience of administration were noteworthy. In 6/7 patients who had been given the liposomal drug after experiencing severe side effects (primarily hypokalemia and marked elevation of serum creatinine) on the non-liposomal form, the problems that had led to institution of the liposomal drug were reversed during treatment. However, multilamellar liposomal amphotericin B at conventional dosage was not without detectable toxicity in this patient population. Three transplant patients receiving cyclosporin at the same time as liposomal amphotericin B experienced a rise in serum creatinine, and 4 patients became hypokalemic during treatment: none of these effects was severe or required discontinuation of therapy. One or more liver enzymes rose measurably in 7 patients during treatment with liposomal amphotericin B, but remained unchanged or actually decreased in the remaining patients.

Enhancement of in vivo adenovirus-mediated gene transfer and expression by prior depletion of tissue macrophages in the target organ

“…With this caveat, the observation in the present study may have important applications for human gene therapy. Both liposomes of the type used in this study (27) and Cl 2 MBP have been used intravenously in humans (25), and thus it is feasible that this strategy of transient depletion of tissue macrophages may be applicable to in vivo Ad-mediated gene transfer in the clinical setting.…”

Carrier effects on biological activity of amphotericin B.

“…The early studies with this formulation were summarized in the late 1980s. More recently, Ralph et al (159) investigated the use of AmB MLV formulations as a routine alternative to Fungizone. The MLV preparations proved to be useful as a direct replacement for Fungizone at the same dosage in patients commonly seen in an infectious disease service.…”

Fungal endocarditis — a report on seven cases and a brief review

“…2 without any side effect. The toxicity of AmBisome is considerably lower than for amphotericin B [31] and a dosage of up to 5 mg/kg/day can be used without severe side effects [32]. AmBisome may also have advantages in the form of better distribution to the site of infection [331.…”