AMPHOTERICIN-B LIPID COMPLEX - RECENT PROGRESS

Fungal infections represent an increasing portion of the opportunistic and hospital-acquired infections and are associated with high morbidi ty and mortality. For years the field of antifungal chemotherapy was d ominated by amphotericin B despite its severe adverse effects and trea tment failures. Intensive efforts to limit the acute and chronic toxic ity of the drug without attenuating its clinical efficacy and broad sp ectrum of activity have led to the development of the newer lipid form ulations of amphotericin B. Amphotericin B lipid complex is a promisin g new formulation containing the active compound tightly packed in rib bon-like lipid structures (7:3 DMPC/DMPG with amphotericin B 35 mol %) . Numerous in vitro and animal studies have shown that ABLC has the sa me spectrum of activity with amphotericin B-deoxycholate, with reduced toxicity and improved pharmacokinetics and pharmacodynamics. Recently completed human studies, including randomized controlled trials, clea rly suggest that ABLC is at least as effective and much better tolerat ed than conventional amphotericin B in the treatment of invasive candi diasis, aspergillosis and other life-threatening fungal infections. Cu rrently, the use of ABLC should be considered for patients refractory, or intolerant to amphotericin B. The exact role of ABLC and the other lipid formulations in the management of serious mycoses in selected p atient populations should be clarified by further clinical trials and cost-efficacy analyses.