Invasive Fungal Infections – Role of Liposomal Amphotericin B

Amphotericin B is an antifungal drug and is developed from Streptomyces nodosus The molecule was developed in 1955 and came in medical practice in 1958. Mechanism of Action Case Synopsis Case presentation: A 60-year-old woman presented with a c/o high-grade fever in the outpatient clinic. Past medical history: History of diabetes 12 years, prosthetic valve with tricuspid valve 3 months ago and history of recent hospitalization History of acute Kidney injury Physical examination: Febrile: 101.2°F with signs of shock BP: 90/60 mm of Hg, HR: 120 beats/min and weak pulse, RR= 18/min Probable diagnosis:  Septic shock Investigations and findings: Trans-oesophageal echocardiography of prosthetic valve showing vegetation. Mean glucose level: 268 mg/dl. Management: Considering recent hospitalisations and continued fever – suspected Nosocomial infection and started with empirical treatment of Meropenem and Teicoplanin. Blood cultures taken showed Candida. The patient started on Caspofungin. Two days later Candida species were identified as Candida parapsilosis. Voriconazole added to Caspofungin (Amphotericin not prescribed due to acute kidney injury) After 2 days, symptoms of Fungemia still persisted. Regimen changed to Liposomal amphotericin B with dosing of 3 mg/kg body weight. 1 week later – No further Candida growth from the blood culture. After 2 months of therapy- no significant nephrotoxicity, creatinine improved. Discharged and advised for follow-up with Cardiologist. Conclusion: Liposomal Amphotericin B being a broad spectrum was successful in managing this patient with minimal or no side effects and satisfactory outcomes. An educational initiative by Glenmark Pharmaceuticals Ltd   723

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