Lipid formulations of amphotericin B: clinical efficacy and toxicities.

@article{WongBeringer1998LipidFO,
  title={Lipid formulations of amphotericin B: clinical efficacy and toxicities.},
  author={Annie Wong-Beringer and Richard A. Jacobs and B. Joseph Guglielmo},
  journal={Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
  year={1998},
  volume={27 3},
  pages={
          603-18
        }
}
Commercially available lipid formulations of amphotericin B (Abelcet, Amphotec, and AmBisome) represent a significant advance in drug delivery technology. Differences in biochemical, pharmacokinetic, and pharmacodynamic properties among the lipid products have been shown in in vitro and in vivo models. Clinical experience with these products has been primarily in patients either refractory to or intolerant of conventional amphotericin B deoxycholate (AmBd). None of the lipid-based products… 
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Postapproval experience has shown substantial efficacy for less common mycotic pathogens including zygomycosis, and the precise position of ABLC versus both other lipid formulations and expanding formulary of new antifungal agents is in flux.
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  • 2000
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Animal models provide evidence that low doses of a lipid formulation are as successful in reducing fungal dissemination and in prolonging survival as higher doses, although concomitant tissue fungal eradication is not as effectively achieved by the lower doses (survival‐mycologic eradication dissociation).
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TLDR
The few comparative clinical trials that have been completed with the lipid-associated formulations have not demonstrated important clinical differences among these agents and amphotericin B for efficacy, although there are significant safety benefits of the lipid products.
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TLDR
Discussion of current national guidelines as well as those used at the institution are presented to provide guidance for the development of institution specific guidelines for the most cost‐effective drug for most patients.
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Modifications of liposomal surface in order to avoid RES uptake, thus increased targetability has been attempted, and newer formulations of AmB allow patients to receive higher doses for longer periods of time with decreased renal toxicity than conventional AmB.
New antifungal agents and preparations
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