Viviani M A, Rizzardini G, Tortorano A M, Fasan M, Capetti A, Roverselli A M, Gringeri A, Suter F
Laboratorio di Micologia Medica, Università degli Studi di Milano, Italy.
Infection. 1994 Mar-Apr;22(2):137-42. doi: 10.1007/BF01739025.
Amphotericin B is the only antifungal drug which, despite its dose-limiting toxicity, can be given intravenously when an aggressive treatment is required. In an attempt to reduce the drug toxicity while retaining its therapeutic efficacy, new formulations of amphotericin B have been developed. The most promising have employed lipid vehicles such as liposomes. Three lipid-based amphotericin B formulations have been developed by pharmaceutical companies and are under active clinical investigation. Efficacy and safety data of these derivatives in animals and humans are reviewed, with particular concern to cryptococcal infection. The authors' experience with a small unilamellar liposomal amphotericin B formulation, AmBisome, in the primary therapy of cryptococcosis is reported. Nine AIDS patients affected with cryptococcosis, seven of whom had meningitis, were given AmBisome (3 mg/kg/day) for 3-6 weeks. Complete response was obtained in six patients, marked improvement in two, and failure in one. AmBisome was well tolerated and shortened the time to clinical and mycological response suggesting a further improvement in the management of cryptococcosis in AIDS patients.
两性霉素B是唯一一种尽管存在剂量限制性毒性，但在需要积极治疗时仍可静脉给药的抗真菌药物。为了在保留其治疗效果的同时降低药物毒性，已开发出两性霉素B的新制剂。最有前景的制剂采用了脂质载体，如脂质体。制药公司已开发出三种基于脂质的两性霉素B制剂，目前正在进行积极的临床研究。本文综述了这些衍生物在动物和人类中的疗效和安全性数据，尤其关注隐球菌感染。报告了作者使用小单层脂质体两性霉素B制剂（安必素）对隐球菌病进行初始治疗的经验。9例患有隐球菌病的艾滋病患者，其中7例患有脑膜炎，接受了安必素（3mg/kg/天）治疗3 - 6周。6例患者完全缓解，2例显著改善，1例治疗失败。安必素耐受性良好，缩短了临床和真菌学反应时间，提示艾滋病患者隐球菌病的治疗管理有进一步改善。
