Invasive fungal infections are associated with a poor outcome and their incidence is rising.
Amphotericin B has for a long time been the gold standard for treatment of these
infections, but the conventional formulation is associated with a high incidence of adverse events.
Lipid formulations of
amphotericin, developed to overcome these drawbacks, are now routinely used in clinical practice for the treatment of
invasive fungal infections in immunocompromised patients.
Amphotericin B lipid complex (ABLC) is prepared from
amphotericin complexed to two
phospholipids, a process that confers a number of important pharmacodynamic and pharmacokinetic properties compared with conventional
amphotericin B. The results of retrospective observational studies and the analysis of databases, including the large Collaborative Exchange of Antifungal Research (CLEAR) database, have shown ABLC to be associated with response rates of up to about 80% in patients with confirmed
fungal infections and around 60% in those treated empirically.
Intranasal administration of ABLC for prophylaxis of
invasive fungal infection in immunocompromised patients is safe and appears to be a promising treatment strategy for the future. ABLC is associated with a substantially lower incidence of nephrotoxicity than conventional
amphotericin. Infusion-related reactions also occur less frequently than with conventional
amphotericin and can be managed using
premedication protocols. When direct and indirect costs are measured, ABLC appears to be less expensive than conventional
amphotericin. The number of approved
antifungal agents that are effective treatments for
invasive fungal infections is increasing. However,
lipid formulations of
amphotericin, such as ABLC, are effective and well tolerated and remain the standard of care in the treatment of
invasive fungal infections. Treatment strategies such as
intranasal administration for prophylaxis and combination
therapy with newer agents are future directions for these agents.