[Epidemiology and therapy of mycotic infections in immunocompromised host with special regard to the role of lipid formulations of amphotericin B].
The extensive use of antifungal prophylaxis may have played a role in the increased incidence of invasive fungal infections in immunocompromised patients. Amphotericin B remains the antifungal agent with the broadest spectrum of action available and is thus the standard treatment for immunocompromised patients with proven or suspected fungal infections, especially aspergillosis. However, its potential for nephrotoxicity limits its usefulness. Lipid formulations of amphotericin B may allow therapy to be administered with reduced renal toxicity. Three different lipid formulations of amphotericin B are currently available. These compounds have different pharmacokinetics properties and usually achieve higher serum and/or tissue concentrations than amphotericin B. At present, there are no studies comparing the lipid formulations with each other and only a few randomized trials comparing them with conventional amphotericin B. However, a number of open clinical trials and compassionate-use protocols suggest that lipid-based forms of amphotericin B can achieve good response rates with minimal toxicity in patients with a variety of invasive mycoses, including those who have proved refractory or intolerant to previous therapy with conventional amphotericin B. Unfortunately, the cost of these compounds remains very high and may represent a limiting factor to their use.
Viscoli
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Nucleo Operativo Malattie Infettive dell'Ospite Compromesso, Università di Genova. viscolic@unige.it
Castagnola
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D000666:Amphotericin B / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D001230:Aspergillus / Q000187:drug effects; D002175:Candida / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy; D004352:Drug Resistance, Microbial; D006801:Humans; D016867:Immunocompromised Host; D008055:Lipids; D008081:Liposomes; D009181:Mycoses / Q000188:drug therapy* / Q000453:epidemiology*; D009369:Neoplasms / Q000276:immunology*; D012307:Risk Factors
D000935:Antifungal Agents; D008055:Lipids; D008081:Liposomes; D000666:Amphotericin B
Epidemiologia e terapia delle infezioni micotiche nell'ospite immunocompromesso, con particolare riguardo al ruolo delle formulazioni lipidiche di amfotericina B.