CLINICAL-EXPERIENCE WITH MULTILAMELLAR LIPOSOMAL AMPHOTERICIN-B IN PATIENTS WITH PROVEN AND SUSPECTED FUNGAL-INFECTIONS

Over a 3-year period, an unsonicated multilamellar vesicle preparation containing a low ratio of amphotericin B (5 mole %) was used as a rou tine alternative to amphotericin B-deoxycholate in treating 17 patient s with a variety of systemic fungal infections representative of those commonly encountered on a tertiary care centre infectious disease ser vice. Patient acceptability and convenience of administration were not eworthy. In 6/7 patients who had been given the liposomal drug after e xperiencing severe side effects (primarily hypokalemia and marked elev ation of serum creatinine) on the non-liposomal form, the problems tha t had led to institution of the liposomal drug were reversed during tr eatment. However, multilamellar liposomal amphotericin B at convention al dosage was not without detectable toxicity in this patient populati on. Three transplant patients receiving cyclosporin at the same time a s liposomal amphotericin B experienced a rise in serum creatinine, and 4 patients became hypokalemic during treatment: none of these effects was severe or required discontinuation of therapy. One or more liver enzymes rose measurably in 7 patients during treatment with liposomal amphotericin B, but remained unchanged or actually decreased in the re maining patients.