From the Guidelines
Amphotericin B plays a crucial role in treating severe and complicated fungal pneumonia, particularly in cases of coccidioidomycosis and other invasive fungal infections.
Key Points
- Amphotericin B is often used as initial therapy for severe fungal pneumonia, especially in patients with significant hypoxia or rapid deterioration 1.
- In cases of coccidioidomycosis, Amphotericin B is the treatment of choice during pregnancy due to its safety profile and effectiveness 1.
- For patients with symptomatic chronic cavitary coccidioidal pneumonia, Amphotericin B or an oral azole such as fluconazole may be used 1.
- In febrile neutropenic patients with lung infiltrates, Amphotericin B is a recommended option for empirical antifungal therapy, particularly in those with suspected invasive mold infections 1.
- The choice of Amphotericin B formulation, such as liposomal Amphotericin B, depends on the patient's risk factors and the potential for adverse effects 1.
Clinical Considerations
- The decision to use Amphotericin B should be based on the severity of the infection, the patient's underlying health status, and the potential risks and benefits of treatment 1.
- Monitoring for adverse effects, such as nephrotoxicity, is essential when using Amphotericin B 1.
- In some cases, Amphotericin B may be used in combination with other antifungal agents or as part of a salvage therapy approach for refractory infections 1.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: aspergillosis, cryptococcosis (torulosis), North American blastomycosis, systemic candidiasis, coccidioido-mycosis, histoplasmosis, zygomycosis including mucormycosis due to susceptible species of the genera Absidia, Mucor and Rhizopus, and infections due to related susceptible species of Conidiobolus and Basidiobolus, and sporotrichosis. The role of Amphotericin B in treating fungal pneumonia is to treat potentially life-threatening fungal infections, including:
- Aspergillosis
- Cryptococcosis
- Histoplasmosis These infections can cause fungal pneumonia. Amphotericin B may be used to treat these conditions 2.
From the Research
Role of Amphotericin B in Treating Fungal Pneumonia
- Amphotericin B remains the gold standard for the treatment of invasive fungal infections, including fungal pneumonia, with response rates ranging from 10% to 80% 3.
- The efficacy of Amphotericin B is limited by its toxicity, particularly nephrotoxicity, which can be reduced by using lipid-based formulations 3, 4.
- Lipid-based formulations of Amphotericin B, such as Amphotericin B lipid complex (ABLC), liposomal Amphotericin B (L-AmB), and Amphotericin B colloidal dispersion (ABCD), have been developed to improve efficacy and reduce toxicity 3, 5.
- These formulations have been shown to be effective in treating various invasive fungal infections, including aspergillosis, candidiasis, and mucormycosis, with response rates ranging from 42% to 82% 3, 5.
- Liposomal Amphotericin B is considered a safer alternative to conventional Amphotericin B, with at least equivalent efficacy and reduced nephrotoxicity 5, 6.
- For the treatment of fungal pneumonia, liposomal Amphotericin B at 3 mg/kg per day is considered a preferred alternative to voriconazole, particularly in cases of contraindication, drug-related side-effects, or intolerance 7.
Lipid-Based Formulations of Amphotericin B
- ABLC is prepared from Amphotericin complexed to two phospholipids, which confers important pharmacodynamic and pharmacokinetic properties compared to conventional Amphotericin B 6.
- L-AmB is a truly liposomal formulation that avoids substantial recognition and uptake by the mononuclear phagocyte system, resulting in higher peak plasma levels and a larger area under the concentration-time curve 5.
- ABCD complexes remain largely intact and are rapidly removed from the circulation by cells of the macrophage phagocyte system, with a recommended dose of 3-4 mg/kg/day 3, 5.
Treatment Strategies
- Combination therapy with newer agents and intranasal administration of ABLC for prophylaxis are potential future directions for the treatment of invasive fungal infections, including fungal pneumonia 6, 7.
- Therapeutic drug monitoring of mold-active azoles should be implemented to minimize toxicity and maximize efficacy 7.
- Surgical debridement of necrotic tissue should be considered as an adjunct to optimal antifungal therapy whenever possible 7.