Early Experiences with Intrathecal Administration of Amphotericin B Liposomal Formulation at a Neurosurgical Center.

IF 7.4 2区医学 Q1 CLINICAL NEUROLOGY

CNS drugs Pub Date : 2024-03-01 Epub Date: 2024-01-25 DOI:10.1007/s40263-024-01065-4

Michael D Nailor, Kellie J Goodlet, Omar Gonzalez, J Tyler Haller

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引用次数: 0

Abstract

Background: Intrathecal administration of amphotericin B represents an important adjunctive therapy for management of severe fungal meningitis. Intrathecal preparations have traditionally used amphotericin B deoxycholate. Liposomal amphotericin B is an alternative formulation with good clinical outcomes as systemic therapy, but scant data exist investigating intrathecal use.

Objective: The aim of this exploratory study was to evaluate outcomes following intrathecal administration of liposomal amphotericin B for treatment of severe fungal meningitis.

Methods: A national shortage of amphotericin B deoxycholate necessitated revision of institutional protocols at a southwestern neurosurgical center in Spring 2023. A starting intrathecal daily dose of 0.125-0.5 mg liposomal amphotericin B was recommended (dependent on insertion device), with 0.125-0.25 mg slow titration every 48 h and up to a 2 mg maximum daily dose.

Results: Four cases of fungal meningitis treated with adjunctive intrathecal amphotericin B liposomal formulation were reviewed. This included three cases of coccidioidal meningitis and one case of presumed Fusarium solani meningitis following an outbreak. All patients had initial disease improvement following initiation of intrathecal amphotericin B and were able to tolerate long-term therapy. One coccidioidal meningitis patient expired of neurologic complications shortly after being moved from the intensive care unit (ICU) to a floor unit. All other patients were successfully discharged from the hospital. New headache was the only reported adverse effect, which was managed with dose reduction and did not require therapy discontinuation.

Conclusions: Liposomal amphotericin B may be feasibly administered intrathecally for the adjunctive treatment of severe fungal meningitis.

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神经外科中心鞘内注射两性霉素 B 脂质体制剂的早期经验

背景：鞘内注射两性霉素 B 是治疗严重真菌性脑膜炎的重要辅助疗法。鞘内制剂传统上使用脱氧胆酸两性霉素 B。两性霉素 B 脂质体是一种替代制剂，在全身治疗中具有良好的临床效果，但有关鞘内使用的研究数据却很少：这项探索性研究旨在评估鞘内注射两性霉素 B 脂质体治疗严重真菌性脑膜炎的疗效：2023年春，由于全国性的两性霉素B脱氧胆酸盐短缺，西南部的一家神经外科中心不得不修改了治疗方案。建议鞘内注射的起始剂量为每天 0.125-0.5 毫克脂质体两性霉素 B（取决于插入装置），每 48 小时缓慢滴定 0.125-0.25 毫克，每天最大剂量为 2 毫克：结果：回顾了四例使用辅助鞘内两性霉素 B 脂质体制剂治疗真菌性脑膜炎的病例。其中包括三例球孢子菌脑膜炎和一例疫情爆发后的假定梭菌脑膜炎。所有患者在开始接受鞘内两性霉素 B 治疗后，病情均得到初步改善，并能耐受长期治疗。一名球孢子菌脑膜炎患者从重症监护室（ICU）转到楼层病房后不久因神经系统并发症去世。其他患者均顺利出院。新出现的头痛是唯一报告的不良反应，经减少剂量处理后，无需停止治疗：结论：脂质体两性霉素 B 可用于腔内给药，辅助治疗重症真菌性脑膜炎。

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来源期刊

CNS drugs 医学-精神病学

CiteScore

12.00

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.