Clearance of fungal burden during treatment of disseminated histoplasmosis with liposomal amphotericin B versus itraconazole

L. J. Wheat, G. Cloud, P. C. Johnson, P. Connolly, M. Goldman, A. Le Monte, D. E. Fuller, Thomas Davis, R. Hafner

Research output: Contribution to journalArticle

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Abstract

Animal studies have shown that fungal burden correlates with survival during treatment with new antifungal therapies for histoplasmosis. The purpose of this report is to compare the clearance of fungal burden in patients with histoplasmosis treated with liposomal amphotericin B versus itraconazole. In two separate closed clinical trials that evaluated the efficacy of liposomal amphotericin B and itraconazole treatment of disseminated histoplasmosis in patients with AIDS, blood was cultured for fungus and blood and urine were tested for Histoplasma antigen. The clinical response rates were similar; 86% with liposomal amphotericin B (n = 51) versus 85% with itraconazole (n = 59). Of the patients with positive blood cultures at enrollment, after 2 weeks of therapy cultures were negative in over 85% of the liposomal amphotericin B group versus 53% of the itraconazole group (P = 0.0008). Furthermore, after 2 weeks, median antigen levels in serum fell by 1.6 U in the liposomal amphotericin B group versus 0.1 U in the itraconazole group (P = 0.02), and those in urine fell by 2.1 U in the liposomal amphotericin B group and 0.2 U in the itraconazole group (P = 0.0005). The more rapid clearance of fungemia supports the use of liposomal amphotericin B rather than itraconazole for initial treatment of moderately severe or severe histoplasmosis.

Original languageEnglish
Pages (from-to)2354-2357
Number of pages4
JournalAntimicrobial Agents and Chemotherapy
Volume45
Issue number8
DOIs
StatePublished - 2001

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Histoplasmosis
Itraconazole
Therapeutics
Urine
Fungemia
Histoplasma
Antigens
liposomal amphotericin B
Acquired Immunodeficiency Syndrome
Fungi
Clinical Trials
Survival
Serum

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Clearance of fungal burden during treatment of disseminated histoplasmosis with liposomal amphotericin B versus itraconazole. / Wheat, L. J.; Cloud, G.; Johnson, P. C.; Connolly, P.; Goldman, M.; Le Monte, A.; Fuller, D. E.; Davis, Thomas; Hafner, R.

In: Antimicrobial Agents and Chemotherapy, Vol. 45, No. 8, 2001, p. 2354-2357.

Research output: Contribution to journalArticle

Wheat, L. J. ; Cloud, G. ; Johnson, P. C. ; Connolly, P. ; Goldman, M. ; Le Monte, A. ; Fuller, D. E. ; Davis, Thomas ; Hafner, R. / Clearance of fungal burden during treatment of disseminated histoplasmosis with liposomal amphotericin B versus itraconazole. In: Antimicrobial Agents and Chemotherapy. 2001 ; Vol. 45, No. 8. pp. 2354-2357.
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abstract = "Animal studies have shown that fungal burden correlates with survival during treatment with new antifungal therapies for histoplasmosis. The purpose of this report is to compare the clearance of fungal burden in patients with histoplasmosis treated with liposomal amphotericin B versus itraconazole. In two separate closed clinical trials that evaluated the efficacy of liposomal amphotericin B and itraconazole treatment of disseminated histoplasmosis in patients with AIDS, blood was cultured for fungus and blood and urine were tested for Histoplasma antigen. The clinical response rates were similar; 86{\%} with liposomal amphotericin B (n = 51) versus 85{\%} with itraconazole (n = 59). Of the patients with positive blood cultures at enrollment, after 2 weeks of therapy cultures were negative in over 85{\%} of the liposomal amphotericin B group versus 53{\%} of the itraconazole group (P = 0.0008). Furthermore, after 2 weeks, median antigen levels in serum fell by 1.6 U in the liposomal amphotericin B group versus 0.1 U in the itraconazole group (P = 0.02), and those in urine fell by 2.1 U in the liposomal amphotericin B group and 0.2 U in the itraconazole group (P = 0.0005). The more rapid clearance of fungemia supports the use of liposomal amphotericin B rather than itraconazole for initial treatment of moderately severe or severe histoplasmosis.",
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