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Amphotericin B: How Much Is Enough?

  • Pharmacology and Pharmacodynamics of Antifungal Agents (P Gubbins, Section Editor)
  • Published:
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Abstract

The total curative dose of amphotericin B for any given fungal infection or specific patient is not precisely known. Prior to the availability of lipid formulations of amphotericin B (LFAB), dosing of amphotericin B was dictated by its associated toxicity. The unique pharmacokinetic features of each LFAB have led to differences in their recommended doses. Most published data have evaluated doses of 3–5 mg/kg/day, although niches exist for both higher and lower doses. Low-dose LFAB allows for intravenous broad-spectrum antifungal coverage without drug-drug interactions and with reduced toxicity. High-dose LFAB demonstrates increased fungal clearance in animal models, although this has not translated to improved clinical outcomes for most invasive fungal infections. Although available data do not demonstrate significant benefit associated with high-dose therapy, for liposomal amphotericin B, the data also demonstrate no significant harm. As such, the use of high-dose liposomal amphotericin B for salvage therapy may be a consideration.

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Conflict of Interest

Z Kassamali declares no conflicts of interest.

S Liao declares no conflicts of interest.

LH Danziger has received honoraria from Astellas Pharmaceuticals.

Human and Animal Rights and Informed Consent

All studies by the authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. Written informed consent, when required, was obtained from all participants.

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  1. University of California Los Angeles Health System, Pharmaceutical Services, Box 957423, Los Angeles, CA, 90095, USA

    Zahra Kassamali

  2. University of Illinois, 833 South Wood Street, Suite 164, MC 886, Chicago, IL, 60612, USA

    Siyun Liao & Larry H. Danziger

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  1. Zahra Kassamali
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  2. Siyun Liao
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Correspondence to Larry H. Danziger.

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Kassamali, Z., Liao, S. & Danziger, L.H. Amphotericin B: How Much Is Enough?. Curr Fungal Infect Rep 8, 119–128 (2014). https://doi.org/10.1007/s12281-014-0184-z

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