A comparison of AmBisome® to amphotericin B for treatment of systemic candidiasis in very low birth weight infants

Purpose: Amphotericin B is considered the treatment of choice for systemic candidiasis, but adverse effects may limit its use. An alternative option for the treatment of candidiasis includes lipid preparations of amphotericin B. This study investigated the safety and efficacy of AmBisome (R), a lipid formulation of amphotericin B containing liposomal structures, for the treatment of systemic candidiasis in very low birth weight infants (VLBWI). Materials and Methods: Data from 26 VLBWI treated with AmBisome (R) in the study group (AmBisome group) from October 2003 to July 2006 were compared with data from 20 VLBWl treated with amphotericin B as a historical control (Amphotericin group). This study was a prospective, historical control, multi-center trial. Results: Candida spp. was isolated in 73% (19/26) of the cases for the AmBisome group and 90% (18/20) of the cases for the Amphotericin group. The fungal eradication rate and the time to eradication was 84% (16/19) and 9 +/- 8 days in the AmBisome group, and 89% (16/18) and 10 +/- 9 days in the Amphotericin group, respectively (p = 0.680 vs p = 0.712). The major adverse effects were lower in the AmBisome group (renal toxicity, 21 % vs 55 %, p = 0.029; hepatotoxity, 25% vs 65%, p = 0.014, AmBisome group vs Amphotericin group, respectively). There was no significant difference in mortality attributed to systemic candidiasis (12% in the AmBisome group, 10% in the Amphotericin group, p = 0.868). Conclusion: AmBisome(D is effective and safe for treating systemic fungal infections in VLBWI.