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Clinical Trial
. 2001 Aug;45(8):2354-7.
doi: 10.1128/AAC.45.8.2354-2357.2001.

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

L J Wheat  1 , G Cloud, P C Johnson, P Connolly, M Goldman, A Le Monte, D E Fuller, T E Davis, R Hafner; AIDS Clinical Trials Group; Mycoses Study Group of NIAID
Affiliations
Clinical Trial

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

L J Wheat et al. Antimicrob Agents Chemother. 2001 Aug.

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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Figures

FIG. 1
FIG. 1
Clearance of fungemia with itraconazole (ITRA) or liposomal amphotericin B (AMBISOME). This analysis is restricted to patients with positive results at baseline for whom follow-up cultures were performed.
FIG. 2
FIG. 2
Antigen clearance following treatment with itraconazole (Itra) or liposomal amphotericin B (Ambisome). The analysis is restricted to patients with positive results at baseline who had follow-up specimens after 2 weeks of therapy. Data are expressed as median antigen (Ag) units, the box represents the 25th and 75th percentiles, and the bars represent the 10th and 90th percentiles.
See this image and copyright information in PMC

References

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