Liposomal amphotericin B treatment for rhinocerebral mucormycosis: how much is enough?
Rhinocerebral Mucormycosis is a potentially life-threatening disease, which affects mainly immunocompromised patients. Treatment options include reversing immunosuppression, surgery and systemic and local administration of anti-fungal medication. Amphotericin B is the primary agent employed, but its use is often limited by frequent side effects. Complexing Amphotericin B with lipid structures avoids most of the negative side effects, most importantly the dose-limiting nephrotoxicity. No consensus has been reached regarding the appropriate duration, rate of administration or total dose of treatment. We present a case of a patient suffering from Rhinocerebral Mucormycosis treated by extensive surgery and Liposomal Amphotericin B. He was treated for 29 days at a rate of 3 mg/kg/d and a total dose of 5.6 gram. The dose of Liposomal Aphotericin B used in previously published articles ranged from 1.5 mg/kg/d to 5 mg/kg/d. The response to treatment may be evaluated by physical examination, microbiological cultures, radiological and pathological studies. Taking into account the considerable cost of liposomal Amphotericin B and other lipid complexed formulations, it is imperative to find out what is the appropriate treatment regime for Rhinocerebral and other mucormycosis infections.
Department of ENT/Head and Neck Surgery, Hebrew University, Hadassah School of Medicine, Jerusalem, Israel. handzel@clalit.org.il
Ophir
O
Handzel
Zvi
Z
Landau
Doron
D
Halperin
D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008081:Liposomes; D008297:Male; D009091:Mucormycosis / Q000150:complications / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome
D000935:Antifungal Agents; D008081:Liposomes; D000666:Amphotericin B