Safety and efficacy of Intralipid emulsions of amphotericin B.
To evaluate the clinical role of amphotericin/20% Intralipid emulsions (ILA), we conducted a Medline search of the English literature to locate the relevant case reports and clinical studies involving the use of this formulation. Due to differences in study design and definitions, we applied a set of treatment outcome definitions to determine the clinical efficacy of this treatment modality. Only 37 patients received ILA for the treatment of documented fungal infections. Using our definitions, four were considered successfully treated, one improved, two failed, and 30 were unevaluable. While infusion-related adverse events and nephrotoxicity were reportedly reduced with ILA, use of adjunctive therapies and concomitant nephrotoxic agents, and comparisons with high infusion concentrations complicate evaluation. Furthermore, incomplete and conflicting data exist regarding the physiochemical stability of ILA. The currently available data do not support recommendations for the use of this formulation for the treatment of systemic fungal infections.
Sievers
T M
TM
Department of Pharmaceutical Services, University of California, Los Angeles 90024, USA.
Kubak
B M
BM
Wong-Beringer
A
A
D000666:Amphotericin B / Q000737:chemistry / Q000494:pharmacology* / Q000627:therapeutic use*; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects; D002986:Clinical Trials as Topic; D003454:Cryptococcus / Q000187:drug effects; D004341:Drug Evaluation; D005217:Fat Emulsions, Intravenous / Q000737:chemistry / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D051379:Mice; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
D000935:Antifungal Agents; D005217:Fat Emulsions, Intravenous; D000666:Amphotericin B