Do the new lipid formulations of amphotericin B really work?

Abstract

Over the past two years, there has been a dramatic rise in the prescription of lipid formulations of amphotericin B at our hospital. These compounds now account for a significant proportion of all expenditure on antimicrobial agents. We therefore conducted a review of the efficacy of the lipid formulations of amphotericin B. Only one randomized controlled trial has assessed the efficacy of any of these formulations in treating proven fungal infections, and this is only available in abstract form. Most of the available evidence on the use of lipid formulations is in the form of case series. There are therefore limited data to justify the widespread use of these compounds, and we believe that there are few circumstances when their administration is warranted. We suggest that local policies should be drawn up for the prescription of lipid formulations of amphotericin B, and, until more compelling data are available, that these drugs only be administered after discussion with microbiologists or infectious diseases physicians.