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Review
. 2025 Apr 29;5(1):23.
doi: 10.1186/s44158-025-00236-z.

Role of liposomal amphotericin B in intensive care unit: an expert opinion paper

Linda Bussini  1   2 , Michele Bartoletti  1   2 , Matteo Bassetti  3   4 , Andrea Cortegiani  5   6 , Gennaro De Pascale  7 , Francesco Giuseppe De Rosa  8 , Marco Falcone  9 , Maddalena Giannella  10   11 , Massimo Girardis  12 , Paolo Grossi  13 , Malgorzata Mikulska  3   4 , Paolo Navalesi  14 , Federico Pea  10   15 , Maurizio Sanguinetti  16 , Carlo Tascini  17 , Bruno Viaggi  18 , Pierluigi Viale  19   20
Affiliations
Review

Role of liposomal amphotericin B in intensive care unit: an expert opinion paper

Linda Bussini et al. J Anesth Analg Crit Care. .

Abstract

Introduction: Invasive fungal infections (IFI) are frequent in patients admitted to the intensive care unit (ICU). The use of first-line antifungals like triazoles or echinocandins may be limited by the global spread of multi-drug resistance species, drug-drug interactions, low organ penetration, and some safety concerns in case of multi-organ failure. Liposomal amphotericin B (L-AmB) is a polyene drug with a broad activity against mold and yeast and an acceptable safety profile. To outline the role of L-AmB in the treatment of IFI in critically ill patients, a panel of experts was invited to draw up an expert opinion paper on the appropriate place in therapy of L-AmB in different clinical scenarios of patients admitted to ICU.

Methods: A multidisciplinary group of 16 specialists in infectious disease, microbiology, pharmacology, and intensive care elaborated an expert opinion document through a multi-step approach: (1) the scientific panel defined the items and wrote the statements on the management of IFI in ICU, (2) a survey was submitted to an external panel to express agreement or disagreement on the statements, and (3) the panel reviewed the survey and implemented the final document.

Results: The final document included 35 statements that focused on epidemiology and microbiological rationale of the use of systemic L-AmB in critically ill patients and its potential role in specific clinical scenarios in the ICU.

Conclusion: Systemic L-AmB may represent an appropriate therapeutic choice for IFI in ICU patients with different underlying conditions, especially when the use of first-line agents is undermined. This expert opinion paper may provide a useful guide for clinicians.

Keywords: Antifungal therapy; Aspergillosis; Candidiasis; Critically ill patient; Intensive care unit; Invasive fungal infections; Liposomal amphotericin B; Mold infections.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. Competing interests: • Bartoletti Michele: fees for lectures from Gilead, Advanz, Pfizer, MSD, Biomerieux. Research grant from MSD. • Bassetti Matteo: fees for Consultant activities (Advisory Board), Speaker and research funding from Angelini, Cidara, Gilead, Menarini, MSD, Pfizer, Shionogi, Mundipharma. • Bussini Linda: none • Cortegiani Andrea: fees for lectures and/or advisory board membership from Gilead, MSD, Mundipharma, Pfizer, Shionogi. • De Pascale Gennaro: publication grant from GILEAD. • De Rosa Francesco: lectures’ fees from Gilead Sciences • Falcone Marco: unconditional grants from MSD, Gilead and speaker honoraria from Shionogi, Pfizer, Menarini, MSD, Gilead, GSK, MundiPharma and TermoFisher. • Giannella Maddalena: grants from Pfizer, MSD, Gilead and BioMerieux as a speaker; grants from MSD and Takeda as an advisory board member; research grant from Pfizer. • Girardis Massimo: fees for activity as speaker to congress and consultant to advisory board past 5 years from MSD, PFIZER, ESTOR, BIOMERIEUX, BIOTEST, FRESENIUS, GILEAD, Shionogi, VIATRIS. • Grossi Paolo: advisory board fees’ member from BIOTEST, GILEAD, TAKEDA, ASTRA-ZENECA, ALLOVIR and Speaker’s bureau fees’ member from MSD, GILEAD, BIOTEST, TAKEDA, ASTRA-ZENECA. • Mikulska Malgorzata: lecture or board meeting honoraria from Allovir, Gilead, Janssen, Moderna, Mundipharma, Pfizer and Shionogi; grant to my institution from Gilead. • Navalesi Paolo: research grants from Gilead and consultant for advisory boards for Gilead. • Pea Federico: has participated in speaker’s bureau for AdvanzPharma, Gilead, InfectoPharm, Menarini, MSD, Pfizer, Sanofi-Aventis, Shionogi, Viatris and as consultant for AdvanzPharma, Gilead, MSD, Mundipharma, Pfizer, Shionogi, Viatris • Sanguinetti Maurizio: no conflict of interest • Tascini Carlo: in the last two years I had direct financial relationships with the following companies: Menarini, MSD, Pfizer, Angelini, Gilead, Novartis, Biomerieux, Thermofisher, Zambon, Hikma, Avir Pharma, Shionogi, Biotest, Viatris • Viaggi Bruno: fees from Abbott, Accelerate Diagnostics, Ada, Advanz Pharma, Alifax, Angelini, Becton Dickinson, Bellco, Biomerieux, Biotest, Cepheid, Correvio, Diasorin, Emmegi Diagnostica, Gilead, InfectoPharm, Menarini, MSD Italia, Nordic Pharma, Pfizer, Shionogi, Thermo Fisher Scientific, Viatris • Viale Pierluigi: received payments or honoraria for lectures, presentations, speaker bureaus, advisory board attendance, manuscript writing or educational events from: Alifax, Allianz pharma, Astra Zeneca, Biomerieux, Gilead Sciences, Menarini, MSD, Mundipharma, Pfizer, Shionogi, Viatris

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