What is the current and future status of conventional amphotericin B?
Amphotericin B deoxycholate has been the 'gold standard' treatment for invasive fungal infections for over 40 years. Driven to improve on the renal toxicity of amphotericin B deoxycholate, extensive pharmaceutical research has led to the development of several new antifungals including lipid formulations of amphotericin B, broad-spectrum azoles and echinocandins. Compared with amphotericin B deoxycholate, the lipid formulations of amphotericin B (amphotericin B lipid complex, amphotericin B colloidal dispersion and liposomal amphotericin B) share distinct advantages in improved drug safety, in particular reduced incidence and severity of amphotericin B deoxycholate-related nephrotoxicity. However, the lipid formulations of amphotericin B are significantly more expensive than amphotericin B deoxycholate and, as for many of these new antifungals, there are as yet insufficient published studies to guide clinicians. This paper examines aspects of safety, efficacy, and health economic data for the lipid formulations of amphotericin B in particular, in order to provide a rationale to justify substituting amphotericin B deoxycholate with the lipid formulations of amphotericin B.
Kleinberg
Michael
M
University of Maryland Greenebaum Cancer Center, Baltimore, USA. mkleinbe@umaryland.edu
D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D002177:Candidiasis / Q000188:drug therapy; D002626:Chemistry, Pharmaceutical; D003102:Colloids; D003840:Deoxycholic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D008081:Liposomes; D010713:Phosphatidylcholines / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D010715:Phosphatidylglycerols / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000935:Antifungal Agents; D003102:Colloids; D004338:Drug Combinations; D008081:Liposomes; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination