Practice guidelines for lipid-based amphotericin B in stem cell transplant recipients

R. E. Quilitz*, A. D. Arnold, G. R. Briones, S. P. Dix, C. Ippoliti, L. D. Kennedy, J. L. Lucich, J. Mehta, B. G. Peters, D. S. Tice

*Corresponding author for this work

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

OBJECTIVE: To provide clinicians who practice in the stem cell transplantation (SCT) setting with practical guidelines for the use of lipid-based amphotericin B (AmB) formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections. DATA SOURCES: Recommendations are based on the results of a two-day consensus meeting that convened clinicians versed in the management of infectious complications in patients undergoing SCT. This meeting, which was held October 21-23, 1998, in Orlando, Florida, was sponsored by an educational grant from The Liposome Company. In addition, primary articles were identified by MEDLINE search (1980-December 1999) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS: Immunocompromised patients, particularly patients undergoing high-close chemotherapy with SCT, experience a high degree of morbidity and mortality from invasive fungal infections. Historically, treatment for such infections with conventional Amb had been limited primarily by its associated nephrotoxicity. Lipid-based formulations of AmB have helped to advance the management of invasive fungal infections in the SCT population by Offering a treatment alternative that allows for administration of adequate amounts of active drug to produce clinical and mycologic responses, compared with conventional AmB, in a delivery system that is less nephrotoxic. Unfortunately, these agents are relatively expensive. Therefore patients who are candidates for lipid-based products must be selected carefully. CONCLUSIONS: Practical guidelines are provided for the use of lipid-based Amb formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections.

Original languageEnglish (US)
Pages (from-to)206-216
Number of pages11
JournalAnnals of Pharmacotherapy
Volume35
Issue number2
DOIs
StatePublished - Jan 1 2001

Keywords

  • Amphotericin
  • Aspergillus
  • Bone marrow transplant
  • Fungal infection
  • Lipid

ASJC Scopus subject areas

  • Pharmacology (medical)

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    Quilitz, R. E., Arnold, A. D., Briones, G. R., Dix, S. P., Ippoliti, C., Kennedy, L. D., Lucich, J. L., Mehta, J., Peters, B. G., & Tice, D. S. (2001). Practice guidelines for lipid-based amphotericin B in stem cell transplant recipients. Annals of Pharmacotherapy, 35(2), 206-216. https://doi.org/10.1345/aph.10041