Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy.
Clin Drug Investig. 2011 Nov 1;31(11):745-58. doi: 10.2165/11593760-000000000-00000.
Invasive fungal infections are associated with a poor outcome and their incidence is rising. Amphotericin B has for a long time been the gold standard for treatment of these infections, but the conventional formulation is associated with a high incidence of adverse events. Lipid formulations of amphotericin, developed to overcome these drawbacks, are now routinely used in clinical practice for the treatment of invasive fungal infections in immunocompromised patients. Amphotericin B lipid complex (ABLC) is prepared from amphotericin complexed to two phospholipids, a process that confers a number of important pharmacodynamic and pharmacokinetic properties compared with conventional amphotericin B. The results of retrospective observational studies and the analysis of databases, including the large Collaborative Exchange of Antifungal Research (CLEAR) database, have shown ABLC to be associated with response rates of up to about 80% in patients with confirmed fungal infections and around 60% in those treated empirically. Intranasal administration of ABLC for prophylaxis of invasive fungal infection in immunocompromised patients is safe and appears to be a promising treatment strategy for the future. ABLC is associated with a substantially lower incidence of nephrotoxicity than conventional amphotericin. Infusion-related reactions also occur less frequently than with conventional amphotericin and can be managed using premedication protocols. When direct and indirect costs are measured, ABLC appears to be less expensive than conventional amphotericin. The number of approved antifungal agents that are effective treatments for invasive fungal infections is increasing. However, lipid formulations of amphotericin, such as ABLC, are effective and well tolerated and remain the standard of care in the treatment of invasive fungal infections. Treatment strategies such as intranasal administration for prophylaxis and combination therapy with newer agents are future directions for these agents.
侵袭性真菌感染与不良预后相关，其发病率正在上升。两性霉素 B 长期以来一直是治疗这些感染的金标准，但常规制剂与不良反应发生率高有关。为克服这些缺点而开发的两性霉素脂质体，现在已在临床实践中常规用于治疗免疫功能低下患者的侵袭性真菌感染。两性霉素 B 脂质复合物（ABLC）是由两性霉素与两种磷脂复合而成，与常规两性霉素 B 相比，这一过程赋予了其许多重要的药效学和药代动力学特性。回顾性观察研究的结果和数据库分析，包括大型合作抗真菌研究交换（CLEAR）数据库，表明 ABLC 可使确诊真菌感染患者的反应率高达约 80%，经验性治疗患者的反应率约为 60%。ABLC 经鼻内给药用于预防免疫功能低下患者侵袭性真菌感染是安全的，似乎是未来有前途的治疗策略。ABLC 与肾毒性的发生率明显低于常规两性霉素。与常规两性霉素相比，输注相关反应也较少发生，并且可以使用预处理方案进行管理。当直接和间接成本进行衡量时，ABLC 似乎比常规两性霉素更便宜。有效的侵袭性真菌感染治疗药物的批准数量正在增加。然而，两性霉素的脂质制剂，如 ABLC，有效且耐受性良好，仍然是侵袭性真菌感染治疗的标准治疗方法。治疗策略，如预防性经鼻内给药和与新型药物的联合治疗，是这些药物的未来发展方向。
