PDF(Pubmed)
Abstract：
Invasive fungal infections pose significant morbidity and mortality risks, particularly those caused by moulds. Available antifungal classes are limited by toxicities and are increasingly susceptible to resistance, particularly amongst challenging fungal pathogens. The purpose of this case series and literature review was to characterize the use of a high-dose lipid formulation of amphotericin B. A case series is presented including patients who received high-dose lipid formulation amphotericin B (≥7.5 mg/kg/day) between June 2012 and August 2021. Additionally, a systematic literature review was conducted by searching the PubMed database for English-language studies involving individuals who received high-dose amphotericin B therapy (≥7.5 mg/kg) using lipid formulations. Nine patients were included in the case series, receiving an average of 8.9 ± 1.3 mg/kg liposomal amphotericin B over a mean of 11.0 ± 10.8 days predominantly for mould infections including Mucorales, aspergillosis and Fusarium. The patients were primarily cared for in intensive care units, with varying treatment histories and outcomes. A total of 11 studies (n=260 patients) met inclusion criteria for the literature review. Responses to high-dose liposomal amphotericin B ranged from 8% to 100%, often showing favourable outcomes. High doses of liposomal amphotericin B were well tolerated both in the case series and in published literature, with serum creatinine changes being the most commonly reported adverse event. However, multi-patient studies continue to report less than favourable (range 8-62%) response rates. High-dose liposomal amphotericin B, either alone or in combination with other antifungal agents, might be a viable strategy for managing invasive fungal infections when few treatment choices exist. This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections.
摘要：
侵袭性真菌感染具有显著的发病率和死亡率风险。特别是那些由霉菌引起的。可用的抗真菌药物种类受到毒性的限制，并且越来越容易受到耐药性的影响。特别是在具有挑战性的真菌病原体中。本系列病例和文献综述的目的是描述两性霉素B高剂量脂质制剂的使用。本系列病例包括2012年6月至2021年8月期间接受两性霉素B高剂量脂质制剂（≥7.5mg/kg/天）的患者。此外,本研究通过检索PubMed数据库的英文研究进行了系统文献综述,该研究涉及接受使用脂质制剂的大剂量两性霉素B治疗(≥7.5mg/kg)的个体.病例系列包括9名患者，在平均11.0±10.8天内平均接受8.9±1.3mg/kg脂质体两性霉素B，主要用于包括Mucorales在内的霉菌感染，曲霉病和镰刀菌。病人主要在重症监护室接受治疗,不同的治疗历史和结果。共有11项研究（n=260例患者）符合文献综述的纳入标准。对高剂量脂质体两性霉素B的反应范围为8％至100％，经常表现出有利的结果。在病例系列和已发表的文献中，高剂量的脂质体两性霉素B的耐受性良好。血清肌酐变化是最常见的不良事件。然而,多患者研究报告的缓解率继续低于有利(范围8-62%).大剂量两性霉素B脂质体,单独或与其他抗真菌药物联合使用，当治疗选择很少时，可能是管理侵袭性真菌感染的可行策略。本文是侵袭性真菌感染管理中的挑战和策略的一部分特刊：https://www.drugsincontext.com/special_issues/challenge-and-strategies-in-the-the-management-of-侵袭性真菌感染.
