Sinonasal mucormycosis and liposomal amphotericin B: A quest for dose optimization
Smile Kajal
Sinonasal mucormycosis and liposomal amphotericin B: A quest for dose optimization - Vol.54(2), Mar-Apr - Mumbai Wolter Kluwer 2022 - 90-96p.
OBJECTIVES: Sinonasal mucormycosis is a serious fungal infection. Early diagnosis and prompt
antifungal therapy along with surgical intervention is the key to its management. Liposomal
amphotericin B (LAmB) given intravenously is the antifungal agent of choice. However, the current
literature is not clear on its optimum dosage. We did a retrospective study to find the optimum dose
of LAmB in cases with sinonasal mucormycosis.
MATERIALS AND METHODS: Thirty patients diagnosed with mucormycosis involving sinonasal,
rhino‑orbital, or rhino‑orbito‑cerebral regions and receiving only LAmB as pharmacotherapy were
included in our retrospective study from 2017 to 2020. A multiple logistic regression model was
developed to correlate the total dose of LAmB and other parameters with the final outcome which
was defined clinico‑radiologically as improved, worsened, or death. The dose of LAmB which led to
the first significant change in urea, creatinine, and potassium levels was also determined.
RESULTS: The model showed a good fit in goodness‑to‑fit analysis (Pearson = 0.999,
deviance = 0.995), while the likelihood ratio was statistically significant (0.001). The overall model
prediction was 83.3%. However, the correlation of outcome with any of the variables, including mean
LAmB dose per kilogram (82.2 ± 13.02 mg/kg), was statistically not significant.
CONCLUSION: Many patient‑related factors (such as age, comorbidities, extent of the disease, and
side effects from LAmB therapy), which vary on a case‑to‑case basis, contribute to the outcome in a
mucormycosis patient. The optimum dose of LAmB for improved outcome still requires individualization
guided by experience, till well‑designed studies address the question.
PHARMACOLOGY
Sinonasal mucormycosis and liposomal amphotericin B: A quest for dose optimization - Vol.54(2), Mar-Apr - Mumbai Wolter Kluwer 2022 - 90-96p.
OBJECTIVES: Sinonasal mucormycosis is a serious fungal infection. Early diagnosis and prompt
antifungal therapy along with surgical intervention is the key to its management. Liposomal
amphotericin B (LAmB) given intravenously is the antifungal agent of choice. However, the current
literature is not clear on its optimum dosage. We did a retrospective study to find the optimum dose
of LAmB in cases with sinonasal mucormycosis.
MATERIALS AND METHODS: Thirty patients diagnosed with mucormycosis involving sinonasal,
rhino‑orbital, or rhino‑orbito‑cerebral regions and receiving only LAmB as pharmacotherapy were
included in our retrospective study from 2017 to 2020. A multiple logistic regression model was
developed to correlate the total dose of LAmB and other parameters with the final outcome which
was defined clinico‑radiologically as improved, worsened, or death. The dose of LAmB which led to
the first significant change in urea, creatinine, and potassium levels was also determined.
RESULTS: The model showed a good fit in goodness‑to‑fit analysis (Pearson = 0.999,
deviance = 0.995), while the likelihood ratio was statistically significant (0.001). The overall model
prediction was 83.3%. However, the correlation of outcome with any of the variables, including mean
LAmB dose per kilogram (82.2 ± 13.02 mg/kg), was statistically not significant.
CONCLUSION: Many patient‑related factors (such as age, comorbidities, extent of the disease, and
side effects from LAmB therapy), which vary on a case‑to‑case basis, contribute to the outcome in a
mucormycosis patient. The optimum dose of LAmB for improved outcome still requires individualization
guided by experience, till well‑designed studies address the question.
PHARMACOLOGY