Ng T T, Denning D W
Department of Infectious Diseases and Tropical Medicine, North Manchester (England) General Hospital.
Arch Intern Med. 1995 May 22;155(10):1093-8.
Invasive fungal infections in the immunocompromised patient are associated with substantial mortality. The use of conventional amphotericin B, the main-stay of treatment, has often been limited by its adverse effects. The incorporation of amphotericin B into liposomes enables more drug to be given without an increase in adverse reactions. We examined the efficacy of AmBisome (Vestar Inc, San Diego, Calif), a small unilamellar liposomal formulation of amphotericin B, in the treatment of mycologically proven systemic fungal diseases.
A retrospective analysis of the "Compassionate Use of AmBisome" in 58 patients who were treated in 34 centers throughout the United Kingdom between July 1990 and August 1992, before licensure of the drug.
Thirty patients had a definite or probable mycologic diagnosis, including 17 who had invasive aspergillosis, nine with Candida infections (three with mucosal disease only), three with zygomycosis, and one with cryptococcal meningitis. The overall response rate was 59% for patients with aspergillosis (80% for those who had had no prior therapy with amphotericin B) and 56% for those with candidosis. More than 40% of those in whom AmBisome was used as "salvage therapy" responded. A daily dose of up to 5 mg/kg was tolerated with minimal side effects.
AmBisome is efficacious in the treatment of invasive fungal infections and provides an alternative therapy for those who fail to respond or become intolerant to conventional amphotericin B therapy.
免疫功能低下患者发生侵袭性真菌感染与相当高的死亡率相关。作为主要治疗药物的传统两性霉素B的使用常常因其不良反应而受到限制。将两性霉素B包裹于脂质体中可在不增加不良反应的情况下给予更多药物。我们研究了两性霉素B的一种小单层脂质体制剂安必素（Vestar公司，加利福尼亚州圣地亚哥）在治疗经真菌学证实的系统性真菌病中的疗效。
对1990年7月至1992年8月在英国34个中心治疗的58例患者进行“安必素同情用药”的回顾性分析，当时该药物尚未获得许可。
30例患者有明确或可能的真菌学诊断，其中17例为侵袭性曲霉病，9例为念珠菌感染（3例仅为黏膜疾病），3例为接合菌病，1例为隐球菌性脑膜炎。曲霉病患者的总体缓解率为59%（未接受过两性霉素B治疗的患者为80%），念珠菌病患者为56%。超过40%将安必素用作“挽救疗法”的患者有反应。每日剂量高达5mg/kg时耐受性良好，副作用最小。
安必素在治疗侵袭性真菌感染方面有效，为那些对传统两性霉素B治疗无反应或不耐受的患者提供了一种替代疗法。
