TREATMENT OF DISSEMINATED MYCOTIC INFECTIONS - A NEW APPROACH TO AMPHOTERICIN B THERAPY

Because dose-related toxicity is a regular accompaniment of amphotericin B therapy, a therapeutic approach has been utilized which allows individualization of dosage. Amphotericin was administered daily in amounts sufficient to provide peak serum levels at least twice those necessary for inhibition of the infecting fungus for a ten week period. Total doses much smaller than those generally recommended were frequently sufficient to control systemic mycotic infections. Fifteen patients with cryptococcosis, disseminated histoplasmosis and blastomycosis have been treated in this manner. Therapeutic results have been excellent. Eleven patients are alive and free of disease an average of twenty-four months after a single course of therapy. Two patients have died of myocardial infarction, one during therapy and the other three months after therapy. In neither case was there evidence of active fungal infection at the time of death. One patient was killed twenty-six months after the completion of amphotericin therapy for pulmonary cryptococcosis. Only one (questionable) relapse occurred in a patient with underlying malignant disease. This therapeutic approach provides a more rational basis for administration of amphotericin B to patients with severe mycotic infections and provides guidelines for adjusting dosage in the face of impaired renal function and other underlying medical problems. © 1968.