Adler-Moore J P, Proffitt R T
Department of Biological Sciences, California State Polytechnic University, Pomona, CA 91768, USA.
Clin Microbiol Infect. 2008 May;14 Suppl 4:25-36. doi: 10.1111/j.1469-0691.2008.01979.x.
To reduce the in-vivo toxicity of the broad-spectrum antifungal drug amphotericin B, various lipid formulations of amphotericin B, ranging from lipid complexes to small unilamellar liposomes, have been developed and subsequently commercialized. These structurally diverse formulations differ in their serum pharmacokinetics as well as their tissue localisation, tissue retention and toxicity. These differences can affect the choice of formulation for a given infection, the time of initiation of treatment, and the dosing regimen. Although preclinical studies have shown similarities in the in-vitro and in-vivo antifungal activity of the formulations with comparable dosing, their acute and chronic toxicity profiles are not the same, and this has a significant impact on their therapeutic indices, especially in high-risk, immunosuppressed patients. With the recent introduction of new antifungal drugs to treat the increasing numbers of infected patients, the amphotericin B lipid formulations are now being studied to evaluate their potential in combination drug regimens. With proven efficacy demonstrated during the past decade, it is expected that amphotericin B lipid formulations will remain an important part of antifungal drug therapy.
为降低广谱抗真菌药物两性霉素B的体内毒性,已开发出从脂质复合物到小单室脂质体等多种两性霉素B脂质制剂,并随后实现商业化。这些结构多样的制剂在血清药代动力学以及组织定位、组织滞留和毒性方面存在差异。这些差异会影响针对特定感染的制剂选择、治疗起始时间和给药方案。尽管临床前研究表明,在给药剂量相当的情况下,这些制剂的体外和体内抗真菌活性具有相似性,但其急性和慢性毒性特征并不相同,这对它们的治疗指数有重大影响,尤其是在高危、免疫抑制患者中。随着近期有新的抗真菌药物用于治疗越来越多的感染患者,目前正在对两性霉素B脂质制剂进行研究,以评估其在联合用药方案中的潜力。鉴于在过去十年中已证明其疗效,预计两性霉素B脂质制剂仍将是抗真菌药物治疗的重要组成部分。
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