LIPID FORMULATIONS OF AMPHOTERICIN-B

Lipid formulations of amphotericin B have demonstrated reduced toxicit y compared with conventional amphotericin B desoxycholate, allowing hi gher daily dosages, Three preparations with entirely different pharmac okinetic properties are currently approved in several countries: ampho tericin B lipid complex (Abelcet(R)), liposomal amphotericin B (AmBiso me(R)) and amphotericin B colloidal dispersion (Amphocil(R)). Ait thre e lipid formulations of amphotericin B share a decreased nephrotoxicit y even at dosages of 5 mg/kg. These drugs may therefore be given succe ssfully in patients intolerant to conventional amphotericin B, althoug h the rates of acute infusion-related reactions may differ between the m. Although several animal studies showed a higher therapeutic index, high dosages were needed for treatment to be effective, It is unclear whether and at what dose these formulations would have a better effica cy than amphotericin B in clinical use, In-vitro studies, animal exper iments and some clinical data suggest that one should avoid low dosage s (1 mg/kg) of the current lipid formulations in the initial treatment of acute fulminant fungal infections, because the efficacy may be inf erior compared with equal dosages of conventional amphotericin B. A fi nal judgement of the clinical efficacy and relative total cost of trea tment with each individual formulation can only be made by direct comp arative, clinical and pharmacoeconomic studies.