AmBisome in the treatment of fungal infections: the UK experience.

Despite a number of recent advances in diagnosis and treatment strategies, fungal infections remain an important cause of morbidity and mortality in neutropenic and immunosuppressed patients. The main fungal infections are candidosis and aspergillosis, although an increased incidence of rarer fungal infections including Fusarium spp., Aurebasidium pullulans and Mucor spp. has been noted. Mortality may be decreased with earlier diagnosis and aggressive treatment with lipid-associated amphotericin B. Invasive pulmonary aspergillosis (IPA) in the neutropenic host presents particular challenges in terms of diagnosis and therapy. We undertook a prospective study over a 36 month period to link the status of early diagnosis and early aggressive therapy with lipid-associated amphotericin B. Early investigation comprised the use of bronchoscopy and bronchoalveolar lavage together with real-time PCR to detect Aspergillus spp. This combined approach revealed the incidence of proven or probable IPA to be 19%. Early therapy resulted in no mortality from IPA. In treating the rarer fungal species, AmBisome was found to be the most effective agent, and could be used at doses of up to 12 mg/kg with few side effects.