Fatal outcome of disseminated candidosis after allogeneic bone marrow transplantation under treatment with liposomal and conventional amphotericin-B. A report of 4 cases with determination of the Mic values

Scand J Infect Dis. 1996;28(3):313-6. doi: 10.3109/00365549609027181.

Abstract

Four patients undergoing allogeneic bone marrow transplantation were treated with liposomal (3 patients) and conventional (one patient) amphotericin-B for disseminated candidosis. Candida krusei was isolated from 3, and C. glabrata from 1 patient. The patients were treated with liposomal amphotericin-B in doses from 3 to 5 mg/kg. The fourth patient received conventional amphotericin-B in a reduced dose due to renal impairment. The patients died from multiorgan failure due to disseminated fungal infection. In 1 case, the switch to the conventional drug resulted in clearance before death. The 3 fungus isolates, together with the fourth strain obtained from patient no. 4 without any exposition to liposomal amphotericin-B were tested for their susceptibility to conventional, liposomal and discoidal amphotericin-B. All strains showed good sensitivity to the conventional and discoidal drug. The minimal inhibitory concentrations (MIC) of liposomal amphotericin-B were 1 to 3 titre steps higher indicating a reduced sensitivity of the tested strains to this preparation. We conclude that the use of liposomal amphotericin-B is recommended mainly on the base of the low incidence of side-effects. Intensive microbial resistance tests, pharmacokinetic investigations and randomized studies are necessary before the conventional drug is replaced as the gold standard for systemic antimycotic therapy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amphotericin B / administration & dosage*
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / therapeutic use*
  • Bone Marrow Transplantation / adverse effects*
  • Candidiasis / drug therapy*
  • Candidiasis / mortality*
  • Drug Carriers
  • Drug Resistance, Microbial
  • Female
  • Humans
  • Liposomes
  • Male
  • Microbial Sensitivity Tests
  • Renal Insufficiency / complications
  • Transplantation, Homologous / adverse effects*

Substances

  • Antifungal Agents
  • Drug Carriers
  • Liposomes
  • Amphotericin B