title: 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.
authors.affiliation: Department of Medicine, University Hospital, London, Ontario, Canada.
authors.forename: E D
authors.initials: ED
authors.lastname: Ralph
authors.forename: K R
authors.initials: KR
authors.lastname: Barber
authors.forename: C W
authors.initials: CW
authors.lastname: Grant
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D002177:Candidiasis / Q000188:drug therapy; D003404:Creatinine / Q000097:blood; D004337:Drug Carriers; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects; D008081:Liposomes; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*
chemical_list: D004337:Drug Carriers; D008081:Liposomes; D000666:Amphotericin B; D003404:Creatinine