Dose range evaluation of liposomal nystatin and comparisons with amphotericin B and amphotericin B lipid complex in temporarily neutropenic mice infected with an isolate of Aspergillus fumigatus with reduced susceptibility to amphotericin B

Antimicrob Agents Chemother. 1999 Nov;43(11):2592-9. doi: 10.1128/AAC.43.11.2592.

Abstract

Using an isolate of Aspergillus fumigatus that is less susceptible in vivo to amphotericin B than most other isolates, we compared different doses of liposomal nystatin (L-nystatin), liposomal amphotericin B (L-amphotericin), and amphotericin B lipid complex (ABLC) with amphotericin B deoxycholate. Four experiments with intravenously infected neutropenic mice were conducted. A dose of L-nystatin at 10 mg/kg of body weight was toxic (the mice had fits or respiratory arrest). The optimal dosage of L-nystatin was 5 mg/kg daily on days 1, 2, 4, and 7 (90% survival). This was superior to L-amphotericin (5 mg/kg [P = 0.24] and 1 mg/kg [P < 0.0001]), ABLC (5 mg/kg [P = 0.014] and 1 mg/kg [P < 0.0001]), and amphotericin B deoxycholate (5 mg/kg [P = 0.008]). In terms of liver and kidney cultures, L-nystatin (5 mg/kg) was superior to all other regimens (P = 0.0032 and <0.0001, respectively). Higher doses of L-amphotericin (25 and 50 mg/kg) in one earlier experiment were more effective (100% survival) than 1 mg of L-amphotericin per kg and amphotericin deoxycholate (5 mg/kg) in terms of mortality and both liver and kidney culture results and to L-amphotericin (5 mg/kg) in terms of liver and kidney culture results only. ABLC (25 mg/kg) given daily for 7 days was superior to ABLC (50 mg/kg [P = 0.03]) but not to ABLC at 5 mg/kg or amphotericin B deoxycholate in terms of mortality, although it was in terms of liver and kidney culture results. No dose-response for amphotericin B (5 and 1 mg/kg) was demonstrable. In conclusion, in this stringent model, high doses of L-amphotericin and ABLC could overcome reduced susceptibility to amphotericin B deoxycholate, but all were inferior to 5- to 10-fold lower doses of L-nystatin.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amphotericin B / administration & dosage*
  • Amphotericin B / therapeutic use*
  • Animals
  • Antifungal Agents / administration & dosage*
  • Antifungal Agents / therapeutic use*
  • Aspergillosis / drug therapy*
  • Aspergillosis / microbiology
  • Aspergillus fumigatus*
  • Colony Count, Microbial
  • Cyclophosphamide
  • Deoxycholic Acid / administration & dosage*
  • Deoxycholic Acid / therapeutic use*
  • Drug Carriers
  • Drug Combinations
  • Drug Resistance, Microbial
  • Immunosuppressive Agents
  • Liposomes
  • Mice
  • Neutropenia / chemically induced
  • Neutropenia / drug therapy*
  • Neutropenia / microbiology
  • Nystatin / administration & dosage*
  • Nystatin / therapeutic use*

Substances

  • Antifungal Agents
  • Drug Carriers
  • Drug Combinations
  • Immunosuppressive Agents
  • Liposomes
  • Deoxycholic Acid
  • Nystatin
  • Amphotericin B
  • amphotericin B, deoxycholate drug combination
  • Cyclophosphamide