Academic Journal
Does the Evidence Support High-Dose Liposomal Amphotericin B in the Treatment of Mucormycosis?
| Τίτλος: | Does the Evidence Support High-Dose Liposomal Amphotericin B in the Treatment of Mucormycosis? |
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| Συγγραφείς: | Lewis RE; Department of Molecular Medicine, University of Padua, Padua, Italy., Kontoyiannis DP; Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. |
| Πηγή: | The Journal of infectious diseases [J Infect Dis] 2026 Sep 23; Vol. 234 (3), pp. 331-341. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 0413675 Publication Model: Print Cited Medium: Internet ISSN: 1537-6613 (Electronic) Linking ISSN: 00221899 NLM ISO Abbreviation: J Infect Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: Jan. 2011- : Oxford : Oxford University Press Original Publication: 1904-2010 : Chicago, IL : University of Chicago Press |
| Ιατρικοί όροι (MeSH): | Mucormycosis*/drug therapy , Amphotericin B*/administration & dosage , Amphotericin B*/pharmacokinetics , Amphotericin B*/adverse effects , Amphotericin B*/therapeutic use , Antifungal Agents*/administration & dosage , Antifungal Agents*/pharmacokinetics , Antifungal Agents*/adverse effects , Antifungal Agents*/therapeutic use, Humans ; Animals ; Dose-Response Relationship, Drug |
| Περίληψη: | Guidelines recommend liposomal amphotericin B (L-AMB) at 5-10 mg/kg/day as first-line therapy for invasive mucormycosis, but whether doses exceeding 5-6 mg/kg/day improve outcomes enough to justify added nephrotoxicity and cost remains unclear. We critically appraised pharmacokinetic, preclinical, and clinical evidence from 58 publications, defining standard-dose L-AMB as 5-6 mg/kg/day and high-dose (HD) L-AMB as >6 mg/kg/day. Animal models show dose-dependent efficacy, but the only prospective trial (Ambizygo) examining HD-L-AMB was a single-arm pilot trial whose response rates were similar to historical 5 mg/kg/day cohorts. Retrospective studies have not found survival benefit favoring HD L-AMB, with consistently higher rates of nephrotoxicity. Saturable pharmacokinetics and altered liposome distribution at doses >10 mg/kg/day may explain this lack of benefit. Routine dose escalation beyond 5-6 mg/kg/day is not supported by current evidence; early diagnosis, surgical debridement, and reversal of immunosuppression appear more critical. However, selected cases may still warrant higher L-AMB doses based on individualized risk-benefit assessment. (© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| Competing Interests: | Potential conflicts of interest. D. P. K. reports research support from Basilea and Astellas Pharma; received consultant fees from Basilea, Knight, Biosegren, Pulmocide, and Avir Pharma; is a member of the data review committee for MundiPharma Therapeutics; is a member of the Mycoses Study Group (MSG)-ERC; and serves as the president of the MSG Research Consortium. R. E. L. receives royalties from UpToDate. |
| Contributed Indexing: | Keywords: high-dose; liposomal amphotericin B; mucormycosis; nephrotoxicity; pharmacokinetics |
| Substance Nomenclature: | 7XU7A7DROE (Amphotericin B) 0 (Antifungal Agents) 0 (liposomal amphotericin B) |
| Entry Date(s): | Date Created: 20260721 Date Completed: 20260923 Latest Revision: 20261001 |
| Update Code: | 20261001 |
| DOI: | 10.1093/infdis/jiag336 |
| PMID: | 42479449 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1537-6613 |
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| DOI: | 10.1093/infdis/jiag336 |