Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis

Although amphotericin B desoxycholate is considered the most effective trea tment for disseminated Paracoccidioides brasiliensis infections, little is known about the efficacy of lipid-based formulations of amphotericin B in t his infection. In this study, we treated four adults with the juvenile form of paracoccidioidomycosis with 3 mg/ kg/day of amphotericin B colloidal di spersion for at least 28 days. Although all of the patients initially respo nded by clinical observation, all four patients relapsed within six months. The use of amphotericin B colloidal dispersion for the initial induction o f paracoccidioidomycosis failed to cure this infection. Possible reasons fo r failure include dose, duration, or reduced efficacy of this lipid prepara tion. For many fungal infections, lipid-based preparations have been shown to have a therapeutic-toxic advantage, but our experience with Paracoccidio ides infections suggests that more careful studies will need to be performe d before they can be recommended for use in this mycosis.