Robinson R F, Nahata M C
Department of Pharmacy, Children's Hospital and College of Pharmacy, Ohio State University, Columbus, USA.
J Clin Pharm Ther. 1999 Aug;24(4):249-57. doi: 10.1046/j.1365-2710.1999.00220.x.
Over the past 15 years, factors suh as corticosteroid treatment, cytotoxic chemotherapy, excessive use of broad spectrum antibiotics and HIV have led to an increased risk of serious fungal infections in both adults and pediatric patients. This increase in invasive fungal infections poses increasing difficulty in their treatment. Three new lipid formulations of amphotericin B are now available in the U.S.: amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). These newer formulations are substantially more expensive, but allow patients to receive higher doses for longer periods of time with decreased renal toxicity than conventional amphotericin B. The properties of these new agents are summarized in this review. Discussion of current national guidelines as well as those used at our institution are presented to provide guidance for the development of institution specific guidelines for the most cost-effective drug for most patients, some may benefit more from one of the newer lipid formulations.
在过去15年中，诸如皮质类固醇治疗、细胞毒性化疗、过度使用广谱抗生素以及感染艾滋病毒等因素，导致成人和儿童患者发生严重真菌感染的风险增加。侵袭性真菌感染的这种增加给其治疗带来了越来越大的困难。目前在美国有三种新的两性霉素B脂质制剂：两性霉素B脂质复合体（Abelcet）、两性霉素B胶体分散体（Amphotec）和脂质体两性霉素B（安必素）。这些较新的制剂价格要贵得多，但与传统两性霉素B相比，能让患者接受更高剂量、更长时间的治疗，同时降低肾毒性。本文综述了这些新药的特性。还介绍了当前的国家指南以及我们机构所使用的指南，以便为制定针对大多数患者最具成本效益药物的机构特定指南提供指导，有些患者可能会从较新的脂质制剂之一中获益更多。
