SAN FRANCISCO-Amphotericin B lipid complex may be the treatment
of choice for patients with hematogenous or invasive candidiasis,
Elias J. Anaissie, MD, said at the 35th Interscience Conference
on Antimicrobial Agents and Chemotherapy (ICAAC).
In the first large randomized comparative trial of a lipid amphotericin
B product vs standard amphotericin B for the treatment of candidiasis,
amphotericin B lipid complex was as effective as standard ampho-tericin
B, with the advantage of being less nephrotoxic, said Dr. Anaissie,
associate professor of medicine, Infectious Diseases Section,
University of Texas M.D. Anderson Cancer Center.
Invasive Candida infections have emerged as a major cause
of morbidity and mortality in immunocompromised patients, Dr.
Anaissie said. Amphotericin B has, until recently, been the mainstay
of treatment for invasive fungal infections because of its broad
spectrum of activity. Its therapeutic utility is limited, however,
by dose-limiting toxicities, particularly nephrotoxicity.
Amphotericin B lipid complex, from The Liposome Company, Princeton,
NJ, is a novel amphotericin B preparation complex with two lipids
in a 1:1 drug-to-lipid ratio.
A prospective, randomized, multicen-ter trial was set up to compare
the efficacy and safety of the two amphotericin B products as
treatment for invasive candi-diasis, Dr. Anaissie said.
In a 27-center study, 231 patients with hematogenous or organ
infection caused by Candida species, 50% of whom had cancer,
were randomly assigned to receive amphotericin B lipid complex,
5 mg/kg/day, or standard amphotericin B, 1 mg/kg/day, for a median
duration of 14 days.
A two-to-one randomization was used, with 153 persons receiving
ampho-tericin B lipid complex, and 78 patients receiving standard
amphotericin B. The most common diagnosis was hematogenous candidiasis
(84%); C albicans accounted for 51% of the infections,
and the remaining cases were caused by a wide variety of Candida