Comprehensive drug utilization review in neonates: liposomal amphotericin B

Objectives: This drug utilization evaluation aims to review current evidence on safety and efficacy of using liposomal amphotericin B (LAMB) in newborns with candidiasis, and compare it to the conventional preparation. Conventional amphotericin B deoxycholate (DAMB) is more commonly used in newborns, but dose-limiting adverse effects may compromise its efficacy. This review will examine the advantages and disadvantages of liposomal amphotericin B and define its place in current practice.

Key findings: The terms 'AmBisome' or 'liposomal amphotericin B' and 'neonatal candidiasis' were entered in both PubMed and Ovid; studies included focused on safety and efficacy of liposomal amphotericin B in newborns with candidiasis, as well as studies comparing the conventional and the liposomal formulations in newborns as monotherapy. Pertinent references obtained from this search were also included. Additionally, pharmacokinetic studies were reviewed to include available data on dosing. Single case reports were not included in the review due to the limited conclusions that can be drawn from such sample sizes and quality of data.

Summary: Although liposomal amphotericin B may be better tolerated and as efficacious as the conventional formulation based on the published literature, the weakness of the studies available on the subject cannot be overlooked. Additional randomized controlled trials are needed to determine the true benefits of this medication.