Practice guidelines for lipid-based amphotericin B in stem cell transplant recipients.
| Autor: | Quilitz RE; Department of Pharmacy, H Lee Moffit Cancer Center, Tampa, FL 33612-9497, USA. quilitz@moffitt.usf.edu, Arnold AD, Briones GR, Dix SP, Ippoliti C, Kennedy LD, Lucich JL, Mehta J, Peters BG, Tice DS |
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| Jazyk: | angličtina |
| Zdroj: | The Annals of pharmacotherapy [Ann Pharmacother] 2001 Feb; Vol. 35 (2), pp. 206-16. |
| DOI: | 10.1345/aph.10041 |
| Abstrakt: | Objective: To provide clinicians who practice in the stem cell transplantation (SCT) setting with practical guidelines for the use of lipid-based amphotericin B (AmB) formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections. Data Sources: Recommendations are based on the results of a two-day consensus meeting that convened clinicians versed in the management of infectious complications in patients undergoing SCT. This meeting, which was held October 21-23, 1998, in Orlando, Florida, was sponsored by an educational grant from The Liposome Company. In addition, primary articles were identified by MEDLINE search (1980-December 1999) and through secondary sources. Study Selection and Data Extraction: All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. Data Synthesis: Immunocompromised patients, particularly patients undergoing high-dose chemotherapy with SCT, experience a high degree of morbidity and mortality from invasive fungal infections. Historically, treatment for such infections with conventional AmB had been limited primarily by its associated nephrotoxicity. Lipid-based formulations of AmB have helped to advance the management of invasive fungal infections in the SCT population by offering a treatment alternative that allows for administration of adequate amounts of active drug to produce clinical and mycologic responses, compared with conventional AmB, in a delivery system that is less nephrotoxic. Unfortunately, these agents are relatively expensive. Therefore, patients who are candidates for lipid-based products must be selected carefully. Conclusions: Practical guidelines are provided for the use of lipid-based AmB formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections. |
| Databáze: | MEDLINE |
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