Treatment of systemic fungal infections with liposomal amphotericin B

Article Abstract:

Fungal infections are relatively common, and are endemic in certain areas of the United States, such as California. Diseases such as coccidioidomycosis, blastomycosis and histoplasmosis were recognized early in this century, but only became well understood in the 1950s. Interest in these diseases as life-threatening illnesses increased with the use of aggressive cancer chemotherapy and steroids, which reduce the number of white blood cells and thus the ability of the body to protect itself from fungal infection. In patients with acute leukemia, the number of fungal infections occurring from 1978 to 1982 was 20 percent of all infections, as compared with 11 percent reported for 1966 to 1972 - perhaps as the result of such aggressive treatment. Standard practice has been to treat these patients with amphotericin B. Although generally effective, the drug has a number of side effects, including fever, chills, hypotension, and anemia. In laboratory animals a preparation of amphotericin B in combination with liposomes, cellular products that contain phospholipid, was found to reduce the drug's toxicity while increasing its effectiveness. The use of liposomal amphotericin B was studied in 46 patients who had various systemic fungal infections, 40 of whom had failed to respond to conventional amphotericin B therapy, and the other six of whom experienced toxic side effects from conventional treatment. Twenty-four of these patients had a complete response to this form of treatment while 22 patients showed no improvement. No long-term toxic effects were recorded, but the patients did experience acute short-term side effects, including fever, chills, and body fluid electrolyte imbalances. Confirming the results of animal experiments, lipososomal amphotericin B therapy was found to be both efficacious and to produce less severe side effects compared with conventional amphotericin B treatment.

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Intestinal cryptosporidiosis treated with eflornithine: a prospective study among patients with AIDS

Article Abstract:

Cryptosporidium is a parasite which causes diarrhea. In patients who have a functioning immune system, the disease is self-limiting and requires no therapy. However, in patients who are immunocompromized, such as those with AIDS, cryptosporidiosis can be life-threatening. The diarrhea can be severe and can cause malabsorption, weight loss, electrolyte imbalance and occasionally perforation of the intestines, leading to death. There is no current effective therapy for cryptosporidiosis. The drug eflornithine was tested in 17 patients with AIDS who had cryptosporidiosis with severe diarrhea. Eflornithine inhibits cell growth and division. Five of the patients (29 percent) responded completely to eflornithine. Their diarrhea resolved and parasites could not be detected in their stools. One additional patient responded to the drug, but had a relapse after the treatment was over. Four of the patients no longer had diarrhea but the parasite was still present in their stools. In total, 59 percent of the patients had some type of positive response to eflornithine. Seven of the patients (41 percent) did not respond to treatment with eflornithine. Therefore, although eflornithine was not effective in all the patients, it was completely effective in stopping the diarrhea and eliminating the parasite in some patients and stopped the diarrhea in others. The side effects of eflornithine include the inhibition of bone marrow cells from dividing, hearing impairment, and intestinal problems. Although the subjects in the study suffered these side effects, they were not severe enough to stop the treatment. Therefore, eflornithine may be useful as a treatment for cryptosporidiosis in AIDS patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Diarrhea, AIDS (Disease), Cryptosporidiosis, Parasitic diseases, Eflornithine

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Nosocomial amphotericin B

Article Abstract:

Fungal infections are relatively common, and are endemic in certain areas of the United States, such as California. Diseases such as coccidioidomycosis, blastomycosis and histoplasmosis were recognized early in this century, but only became well understood in the 1950s. Interest in these diseases as life-threatening illnesses increased with the use of aggressive cancer chemotherapy which is often followed by a fungal infection. In 1956 a broad- spectrum antifungal antibiotic, amphotericin B, was announced and it rapidly became an important drug for the treatment of many fungal infections. However, it remains relatively ineffective for specific fungal infections such as coccidioidomycosis and cryptococcal disease. An article in the Archives of Internal Medicine shows that liposomal amphotericin B is much more effective when the infection involves organs that contain large quantities of particular cells, reticuloendothelial cells. As a result of this selectivity the drug should prove to be useful in treating fungal infections of liver, spleen, lung, or bone marrow. Although the results are encouraging, time and continued experience with liposomal amphotericin B is required before physicians should abandon the older amphotericin product.

editorial

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