Andrès E, Tiphine M, Letscher-Bru V, Herbrecht R
Service de médecine interne et nutrition, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
Rev Med Interne. 2001 Feb;22(2):141-50. doi: 10.1016/s0248-8663(00)00304-0.
Amphotericin B (amB) remains the gold standard for treatment of invasive fungal infections. Lipid formulations of amB have been developed in an attempt to improve both efficacy and tolerability (especially renal toxicity): amB lipid complex (ABLC), liposomal amB (AmBisome), amB colloidal dispersion (ABCD) and amB in lipid emulsion (Intralipid). This review analyzes the data available in the literature.
ABLC, AmBisome and ABCD are effective in various fungal infections, including invasive aspergillosis, systemic candidiasis, cryptococcal meningitis, mucormycosis and fusariosis. These formulations are also effective in persistent febrile neutropenia and in leishmaniosis. The three formulations show little renal toxicity and are safer than conventional amB in this respect. Preliminary data are available on amB in Intralipid: infusion-related adverse effects are reduced, but few data are available on efficacy in documented mycoses.
Large-scale comparative clinical trials may clarify issues of relative efficacy in various forms of fungal infections.
两性霉素B（amB）仍然是治疗侵袭性真菌感染的金标准。已开发出两性霉素B的脂质制剂，试图提高疗效和耐受性（尤其是肾毒性）：两性霉素B脂质复合物（ABLC）、脂质体两性霉素B（安必素）、两性霉素B胶体分散液（ABCD）和脂质乳剂中的两性霉素B（英脱利匹特）。本综述分析了文献中的现有数据。
ABLC、安必素和ABCD对各种真菌感染有效，包括侵袭性曲霉病、系统性念珠菌病、隐球菌性脑膜炎、毛霉病和镰刀菌病。这些制剂对持续性发热性中性粒细胞减少症和利什曼病也有效。这三种制剂显示出极低的肾毒性，在这方面比传统两性霉素B更安全。关于脂质乳剂中的两性霉素B有初步数据：与输注相关的不良反应减少，但关于已记录真菌病疗效的数据很少。
大规模比较临床试验可能会阐明各种形式真菌感染中相对疗效的问题。
