Liposomal amphotericin B treatment for rhinocerebral mucormycosis: how much is enough?

Rhinology. 2003 Sep;41(3):184-6.

Abstract

Rhinocerebral Mucormycosis is a potentially life-threatening disease, which affects mainly immunocompromised patients. Treatment options include reversing immunosuppression, surgery and systemic and local administration of anti-fungal medication. Amphotericin B is the primary agent employed, but its use is often limited by frequent side effects. Complexing Amphotericin B with lipid structures avoids most of the negative side effects, most importantly the dose-limiting nephrotoxicity. No consensus has been reached regarding the appropriate duration, rate of administration or total dose of treatment. We present a case of a patient suffering from Rhinocerebral Mucormycosis treated by extensive surgery and Liposomal Amphotericin B. He was treated for 29 days at a rate of 3 mg/kg/d and a total dose of 5.6 gram. The dose of Liposomal Aphotericin B used in previously published articles ranged from 1.5 mg/kg/d to 5 mg/kg/d. The response to treatment may be evaluated by physical examination, microbiological cultures, radiological and pathological studies. Taking into account the considerable cost of liposomal Amphotericin B and other lipid complexed formulations, it is imperative to find out what is the appropriate treatment regime for Rhinocerebral and other mucormycosis infections.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amphotericin B / administration & dosage*
  • Antifungal Agents / administration & dosage*
  • Dose-Response Relationship, Drug
  • Humans
  • Liposomes
  • Male
  • Mucormycosis / complications
  • Mucormycosis / drug therapy*
  • Sinusitis / drug therapy*
  • Sinusitis / microbiology
  • Surgical Procedures, Operative / methods
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Liposomes
  • Amphotericin B