Liposomal Amphotericin B for Fever and Neutropenia

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Abstract
In their study of liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia (March 11 issue),1 Walsh et al. report that liposomal amphotericin B was associated with fewer breakthrough fungal infections than conventional amphotericin B. We think that the design of this randomized trial was not adequate because the dose of conventional amphotericin B (0.6 mg per kilogram of body weight per day) that was used does not reflect widely used standards of care. Most institutions in Europe and the United States would agree that treatment of this patient population requires a dose of at least 1.0 mg of conventional amphotericin B per kilogram per day to avoid breakthrough fungal infections. In fact, the rate of proved breakthrough fungal infections in the group given conventional amphotericin B is rather high (7.8 percent) and appears to be due to the low dose of conventional amphotericin B chosen.