Sinonasal mucormycosis and liposomal amphotericin B: A quest for dose optimization.

Smile Kajal, Syed Shariq Naeem, Pooja Gupta, Arvind Kumar Kairo, Anam Ahmed, Prankur Verma, Ashish Saini

Indian journal of pharmacology 2022 Mar-Apr

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Sinonasal mucormycosis is a serious fungal infection. Early diagnosis and prompt antifungal therapy along with surgical intervention is the key to its management. Liposomal amphotericin B (LAmB) given intravenously is the antifungal agent of choice. However, the current literature is not clear on its optimum dosage. We did a retrospective study to find the optimum dose of LAmB in cases with sinonasal mucormycosis. Thirty patients diagnosed with mucormycosis involving sinonasal, rhino-orbital, or rhino-orbito-cerebral regions and receiving only LAmB as pharmacotherapy were included in our retrospective study from 2017 to 2020. A multiple logistic regression model was developed to correlate the total dose of LAmB and other parameters with the final outcome which was defined clinico-radiologically as improved, worsened, or death. The dose of LAmB which led to the first significant change in urea, creatinine, and potassium levels was also determined. The model showed a good fit in goodness-to-fit analysis (Pearson = 0.999, deviance = 0.995), while the likelihood ratio was statistically significant (0.001). The overall model prediction was 83.3%. However, the correlation of outcome with any of the variables, including mean LAmB dose per kilogram (82.2 ± 13.02 mg/kg), was statistically not significant. Many patient-related factors (such as age, comorbidities, extent of the disease, and side effects from LAmB therapy), which vary on a case-to-case basis, contribute to the outcome in a mucormycosis patient. The optimum dose of LAmB for improved outcome still requires individualization guided by experience, till well-designed studies address the question.

Citation

Smile Kajal, Syed Shariq Naeem, Pooja Gupta, Arvind Kumar Kairo, Anam Ahmed, Prankur Verma, Ashish Saini. Sinonasal mucormycosis and liposomal amphotericin B: A quest for dose optimization. Indian journal of pharmacology. 2022 Mar-Apr;54(2):90-96