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Treatment of 21 cases of invasive mucormycosis with amphotericin B colloidal dispersion.

Abstract

The aim of this study was to review the characteristics and outcome of 21 patients with invasive mucormycosis treated with amphotericin B colloidal dispersion (ABCD) in five phase I and phase II studies. Mucormycosis is an increasing concern in immunocompromised patients, in whom mortality exceeds 60%. The standard treatment has been amphotericin B combined with surgical debridement. Twenty-one patients with invasive mucormycosis treated with ABCD, a lipid complex of amphotericin B and cholesteryl sulfate, were identified. Patients were given ABCD on the basis of pre-existing renal insufficiency, development of nephrotoxicity during amphotericin B therapy, or fungal infection that failed to respond to amphotericin B. Response could be evaluated in 20 patients, all of whom had bone marrow or organ transplantation, haematologic malignancies, or diabetes. Infection was disseminated in six patients and localised to the sinuses, lower respiratory tract, or skin in the other patients. ABCD was given at a mean dose of 4.8 mg/kg per infusion for a mean duration of 37 days. Twelve of 20 patients responded to ABCD therapy. Response rates were similar when patients were treated with ABCD alone (4/7) and ABCD combined with surgery (8/13), with more complete response obtained in the latter group. No difference in response rate was observed in leukaemic patients (3/5) or transplant recipients (6/10) compared to diabetics (3/5). No renal or hepatic toxicity was observed. These results compare favourably with the results of standard treatment and suggest that ABCD combined with surgery may be a useful therapy in patients with mucormycosis.

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  • Authors

    Herbrecht R, Letscher-Bru V, Bowden RA, Kusne S, Anaissie EJ, Graybill JR, Noskin GA, Oppenheim , Andrès E, Pietrelli LA

    Institution

    Département d'Onco-Hématologie, Hôpital de Hautepierre, Strasbourg, France. raoul.herbrecht@chru-strasbourg.fr

    Source

    European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 20:7 2001 Jul pg 460-6

    MeSH

    Adolescent
    Adult
    Aged
    Amphotericin B
    Child
    Child, Preschool
    Clinical Trials, Phase I as Topic
    Clinical Trials, Phase II as Topic
    Drug Administration Schedule
    Female
    Follow-Up Studies
    Fungemia
    Humans
    Infusions, Intravenous
    Male
    Middle Aged
    Mucormycosis
    Severity of Illness Index
    Survival Rate
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Evaluation Studies
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11561801