[New lipid formulations of amphotericin B. Review of the literature].
BACKGROUND
Amphotericin B (amB) remains the gold standard for treatment of invasive fungal infections. Lipid formulations of amB have been developed in an attempt to improve both efficacy and tolerability (especially renal toxicity): amB lipid complex (ABLC), liposomal amB (AmBisome), amB colloidal dispersion (ABCD) and amB in lipid emulsion (Intralipid). This review analyzes the data available in the literature.


BACKGROUND
ABLC, AmBisome and ABCD are effective in various fungal infections, including invasive aspergillosis, systemic candidiasis, cryptococcal meningitis, mucormycosis and fusariosis. These formulations are also effective in persistent febrile neutropenia and in leishmaniosis. The three formulations show little renal toxicity and are safer than conventional amB in this respect. Preliminary data are available on amB in Intralipid: infusion-related adverse effects are reduced, but few data are available on efficacy in documented mycoses.


CONCLUSIONS
Large-scale comparative clinical trials may clarify issues of relative efficacy in various forms of fungal infections.
Service de médecine interne et nutrition, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France. medecineinterne.ChuHautepierre@Wanadoo.fr
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Andrès
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Tiphine
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Letscher-Bru
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Herbrecht
D000666:Amphotericin B / Q000737:chemistry* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000737:chemistry* / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000737:chemistry* / Q000627:therapeutic use; D002626:Chemistry, Pharmaceutical; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous / Q000737:chemistry; D006801:Humans; D008081:Liposomes; D009503:Neutropenia / Q000188:drug therapy / Q000382:microbiology; D018579:Patient Selection; D010713:Phosphatidylcholines / Q000737:chemistry* / Q000627:therapeutic use; D010715:Phosphatidylglycerols / Q000737:chemistry* / Q000627:therapeutic use; D016896:Treatment Outcome
D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous; D008081:Liposomes; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B