Successful stepdown treatment of pulmonary histoplasmosis with thrice‐weekly liposomal amphotericin B in a hospital‐associated, outpatient infusion centre: A case report

Liposomal amphotericin B (LAmB) is used in the treatment of opportunistic fungal and parasitic infections, including leishmaniasis. Given its lack of known teratogenicity in pregnancy, LAmB is a preferred agent for treatment for these patients. However, significant gaps remain in determining optimal dosing regimens for LAmB in pregnancy. We describe the use of LAmB for a pregnant patient with mucocutaneous leishmaniasis (MCL) using a dosing strategy of 5 mg/kg/day for days 1–7 using ideal body weight followed by 4 mg/kg weekly using adjusted body weight. We reviewed the literature for LAmB dosing strategies, particularly dosing weight, in pregnancy. Of the 143 cases identified in 17 studies, only one reported a dosing weight, in which ideal body weight was used. Five Infectious Diseases Society of America guidelines in total discussed the use of amphotericin B in pregnancy but no guidelines included recommendations for dosing weight. This review describes our experience in using ideal body weight for dosing LAmB in pregnancy for the treatment of MCL. Use of ideal body weight may minimize risk of adverse effects to the fetus compared to the use of total body weight while maintaining efficacy for treatment of MCL in pregnancy.

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“…In total, 143 cases across 17 studies of LAmB use in pregnancy were included in this review (Figure 1). 17,34–49 …”

Section: Resultsmentioning

confidence: 99%

Dosing implications for liposomal amphotericin B in pregnancy

et al. 2023

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“…recommended itraconazole for mild-to-moderate infection and amphotericin B for severe histoplasmosis. 16 Amphotericin B is also being used a stepdown therapy for recurrent pulmonary histoplasmosis 17 and for treating progressive disseminated histoplasmosis in people living with HIV. 18 • Amphotericin B is usually recommended for severe blastomycosis in the lungs or infections that have spread to other parts of the body.…”

Section: Mechanism Of Action Of Antifungals Used In Ifi With Emphasismentioning

confidence: 99%

Review of Amphotericin B for Invasive Fungal Infections in Neonates and Children

2020

Pediatric Infectious Disease

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Formulations of amphotericin B have come a long way since it was initially discovered. Studies of antifungals in the pediatric age-group are limited to those for cutaneous fungal infections. There are a few studies on the pharmacokinetics and safety of amphotericin B, and most dosage recommendations are extrapolated from adult data. A review of its use in the treatment of invasive fungal infections in neonates, children, and adolescents is the focus of this article.

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“…Amb is one of polyene antifungal drugs prescribed for treatment of fungal infections such as leishmaniasis and aspergillosis 45 , 46 , histoplasmosis 47 , cryptococcal meningitis 48 and zygomycosis 49 . Its chemical structure includes a polar hydroxylated portion and a nonpolar hydrocarbon sequence.…”

Section: Introductionmentioning

confidence: 99%

Design of double functionalized carbon nanotube for amphotericin B and genetic material delivery

Yazdani

Mozaffarian

Pazuki

et al. 2022

Sci Rep

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In the present work, single wall carbon nanotubes (SWCNT) were successively functionalized with phospholipid DSPE-PEG carboxylic acid, and then, with ethylenediamine (EDA), to obtain double functionalized single wall carbon nanotube (DFSWCNT). Then, DFSWCNT was applied as a carrier for delivering amphotericin B (Amb) and EGFP plasmid. FSWCNT’s concentration obtained via UV–visible analysis was 0.99 mg/mL. The TGA analysis results provided the lost weights of DSPE-PEG-COOH, EDA, Amb and SWCNT impurities. XPS results showed that carbon atoms’ percentage decreased during the functionalization processes from 97.2% (SWCNT) to 76.4% (FSWCNT) and 69.9% (DFSWNCT). Additionally, the oxygen atoms’ percentage increased from 2.3% (SWCNT) to 21% and 22.5% for FSWCNT and DFSWCNT, respectively. New bonds such as C–N and N–C=O appeared in the synthesized nanocarrier. The IG/ID ratio in Raman analysis decreased from 7.15 (SWCNT) to 4.08 (FSWCNT). The amount of Amb released to phosphate buffer saline medium was about 33% at pH = 5.5 and 75% at pH = 7.4 after 48 h. CCK8 results confirmed that the toxicity of functionalized SWCNT had decreased. In a 2:1 ratio of DFSWCNT/EGFP plasmid, the cell viability (87%) and live transfected cells (56%) were at their maximum values. The results indicate that carbon nanotubes have the potential to be applied as drug/gene delivery systems with outstanding properties such as high loading capacity and easy penetration to cell membrane.

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Successful stepdown treatment of pulmonary histoplasmosis with thrice‐weekly liposomal amphotericin B in a hospital‐associated, outpatient infusion centre: A case report

Abstract: Administration of thrice-weekly liposomal amphotericin in a hospital-associated, outpatient infusion centre may be a promising option for stepdown treatment in patients unable to take itraconazole.

Cited by 8 publications

References 20 publications

Dosing implications for liposomal amphotericin B in pregnancy

Dosing implications for liposomal amphotericin B in pregnancy

Review of Amphotericin B for Invasive Fungal Infections in Neonates and Children

Design of double functionalized carbon nanotube for amphotericin B and genetic material delivery

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