Dosing implications for liposomal amphotericin B in pregnancy

Abstract

Liposomal amphotericin B (LAmB) is used in the treatment of opportunistic fungal and parasitic infections, including leishmaniasis. Given its lack of known teratogenicity in pregnancy, LAmB is a preferred agent for treatment for these patients. However, significant gaps remain in determining optimal dosing regimens for LAmB in pregnancy. We describe the use of LAmB for a pregnant patient with mucocutaneous leishmaniasis (MCL) using a dosing strategy of 5 mg/kg/day for days 1–7 using ideal body weight followed by 4 mg/kg weekly using adjusted body weight. We reviewed the literature for LAmB dosing strategies, particularly dosing weight, in pregnancy. Of the 143 cases identified in 17 studies, only one reported a dosing weight, in which ideal body weight was used. Five Infectious Diseases Society of America guidelines in total discussed the use of amphotericin B in pregnancy but no guidelines included recommendations for dosing weight. This review describes our experience in using ideal body weight for dosing LAmB in pregnancy for the treatment of MCL. Use of ideal body weight may minimize risk of adverse effects to the fetus compared to the use of total body weight while maintaining efficacy for treatment of MCL in pregnancy.

Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature

“…This comprehensive literature review delineates the most important aspects of the disease's manifestation during pregnancy, encompassing geographical distribution, clinical presentations, diagnostic approaches, therapeutic interventions, and perinatal outcomes. It also incorporates a supplementary file (Table S1) that details exceedingly select elucidative rare cases and case series in singleton pregnancies [9,35,37,38,40,41,44,46,[136][137][138][139][140][141][142]. Notably, the incidence of VL in singleton pregnancies within developed countries is markedly low, presenting with a spectrum of clinical signs and symptoms.…”

Comment on “Dosing implications for liposomal amphotericin B in pregnancy”

“…In the May issue of Pharmacotherapy, O'Grady et al highlighted the insufficient knowledge on optimal dosing regimens for liposomal amphotericin B (LAmB) during pregnancy. 1 They advocated for a dosing strategy for pregnant women with mucocutaneous leishmaniasis based on the use of ideal body weight (IBW) and adjusted body weight (ABW) as an alternative to the conventional approach of using total body weight (TBW).…”