Safety and Efficacy of Intermittent High Dose Liposomal Amphotericin B Antifungal Prophylaxis in Haemato Oncology: An Eight Year Single Centre Experience and Review of the Literature
Triazoles remain first line agents for antifungal prophylaxis in high risk haemato oncology patients, but their use is increasingly contraindicated due to drug drug interactions and additive toxicities with novel treatments. In this retrospective, single centre, observational study, we present our eight year experience of antifungal prophylaxis using intermittent high dose liposomal Amphotericin B (L AmB) All adults identified through our Antifungal Stewardship Programme as receiving L AmB prophylaxis at 7.5 mg/kg once weekly between February 2012 and January 2020 were included. Adverse reactions, including infusion reactions, electrolyte loss, and nephrotoxicity, were recorded. 'Breakthrough' invasive fungal infection (IFI) occurring within four weeks of L AmB was classified using European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Moreover, 114 courses of intermittent high dose L AmB prophylaxis administered to 92 unique patients were analysed. Hypokalaemia was the most common grade 3 4 adverse event, with 26 (23% courses. Grade 3 nephrotoxicity occurred in 8 (7% and reversed in all six patients surviving to 90 days. There were two (1.8% episodes of breakthrough IFI, one 'probable' and one 'possible' In this study, the largest evaluation of intermittent high dose L AmB prophylaxis conducted to date, toxicity was manageable and reversible and breakthrough IFI was rare. L AmB prophylaxis represents a viable alternative for patients with a contraindication to triazoles.
Journal of fungi