Liposomal Amphotericin B (AMBISOME) in Patients with Severe Neutropenia and Antibiotic Resistant Fever

Hahn, Uwe; Deboben, A.; Baldauf, G; Goldschmidt, Hartmut; Haas, Richard; Hünstein, W.

doi:10.1007/978-3-642-78350-0_144

Cited by 1 publication

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“…A higher efficacy in febrile neutropenia was suggested by Prentice et al [38], who reported preliminary results of a randomized study to compare AmBisome 1 mg kg-', 3 mg kg-' and conventional amphotericin B in refractory fever of unknown origin and found resolution of fever in 65'10, 73% and 60% of episodes respectively. Because it has fewer side-effects, liposomal amphotericin B may be the drug of choice for empirical therapy, but its high cost does not allow its routine use in adult patients [39]; in children liposomal amphotericin B may be a suitable alternative for therapy [24] and prophylaxis [40].…”

Section: Discussionmentioning

confidence: 99%

Liposomal amphotericin B as early empiric antimycotic therapy of pneumonia in granulocytopenic patients

Böhme

Hoelzer

1996

Mycoses

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Twenty-three neutropenic patients with haematological malignancies and febrile pulmonary infiltrates were empirically treated with liposomal amphotericin B (AmBisome) in addition to broad-spectrum antibiotics. AmBisome was given on alternate days in two different dosages: 3 mg kg-1 in patients with pneumonia but without radiological signs or other evidence of Aspergillus infection and 5 mg kg-1 in pneumonia patients with suspected Aspergillus infection. The main objectives of this study were to compare the response and lethality of pneumonias treated early with empirically AmBisome with a historical group (treatment with conventional amphotericin B only in case of proven/highly probable aspergillosis) and to investigate the tolerability and efficacy of AmBisome 5 mg kg-1 in cases of proven/probable aspergilloses. Six out of seven (86%) patients without initially suspected aspergilloses receiving AmBisome 3 mg kg-1 responded completely. Twelve out of 16 patients with initial radiological signs of aspergillosis receiving AmBisome 5 mg kg-1 were evaluable. Body temperature normalized in 10/12 (83%) patients; eight experienced complete and two partial regression of their infiltrations and 9/10 patients with proven/probable aspergillosis responded. Acute AmBisome-related reactions were seen in three patients from each group; loss of potassium was noted in five subjects in each group and slightly increased plasma creatinine was found in two patients in the 5 mg kg-1 group. Altogether, the response of all pneumonia patients treated with early empirical AmBisome compared with the historical group was 17/19 vs. 49/72 (89% vs. 68%, NS); among those with proven/probable aspergilloses 11/12 vs. 7/17 (92% vs. 41%, P = 0.008) patients responded. Pneumonia lethality was 1/19 in the AmBisome-treated patients compared with 23/72 in the historical group (5% vs. 32%, P = 0.01); and among those with proven/probable aspergilloses it was 1/12 vs. 10/17 (8% vs. 59%, P = 0.008). In conclusion, early empiric treatment with AmBisome 3 mg kg-1 and 5 mg kg-1 on alternate days was well tolerated and greatly reduced the lethality of proven/probable Aspergillus pneumonias.

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Section: Discussionmentioning

confidence: 99%