Treatment of 21 Cases of Invasive Mucormycosis with Amphotericin B Colloidal Dispersion

  • R. Herbrecht
  • V. Letscher-Bru
  • R. A. Bowden
  • S. Kusne
  • E. J. Anaissie
  • J. R. Graybill
  • G. A. Noskin
  • B. A. Oppenheim
  • E. Andrès
  • L.A. Pietrelli
Article

DOI: 10.1007/s100960100528

Cite this article as:
Herbrecht, R., Letscher-Bru, V., Bowden, R. et al. EJCMID (2001) 20: 460. doi:10.1007/s100960100528

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.

Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • R. Herbrecht
    • 1
  • V. Letscher-Bru
    • 2
  • R. A. Bowden
    • 3
  • S. Kusne
    • 4
  • E. J. Anaissie
    • 5
  • J. R. Graybill
    • 6
  • G. A. Noskin
    • 7
  • B. A. Oppenheim
    • 8
  • E. Andrès
    • 9
  • L.A. Pietrelli
  1. 1.Département d'Onco-Hématologie, Hôpital de Hautepierre, 67098 Strasbourg, France e-mail: raoul.herbrecht@chru-strasbourg.fr Tel.: +33-388-127688 Fax: +33-388-167681FR
  2. 2.Institut de Parasitologie et de Pathologie Tropicale, Strasbourg, FranceFR
  3. 3.Providence Seattle Medical Center, Seattle, WA, USAUS
  4. 4.University of Pittsburgh Medical Center, Pittsburgh, PA, USAUS
  5. 5.University of Arkansas for Medical Sciences, Little Rock, AR, USAUS
  6. 6.University of Texas Health Science Center, San Antonio, TX, USAUS
  7. 7.Northwestern University Medical School, Chicago, IL, USAUS
  8. 8.Withington Hospital, Manchester, UKGB
  9. 9.Service de Médecine Interne, Hôpital de Hautepierre, Strasbourg, FranceFR