Adverse effects of amphotericin B in children; a retrospective comparison of conventional and liposomal formulations
- PMID: 29352486
- PMCID: PMC5903243
- DOI: 10.1111/bcp.13521
Adverse effects of amphotericin B in children; a retrospective comparison of conventional and liposomal formulations
Abstract
Aims: Lipid formulations of amphotericin B, rather than conventional amphotericin (c-amB), are increasingly used despite limited data comparing these preparations in children. Data on the incidence of adverse effects with amphotericin B at standard doses are scarce. This study aimed to compare the adverse effects associated with standard doses of c-amB and liposomal amphotericin (l-amB) in children.
Methods: Children admitted to the Royal Children's Hospital Melbourne and treated with c-amB or l-amB between January 2010 and September 2013 were included. Clinical and laboratory data were retrospectively extracted from medical records to compare amphotericin-related infusion reactions, nephrotoxicity (glomerulotoxicity and tubulopathy) and hepatotoxicity.
Results: Seventy-six children received c-amB and 39 received l-amB. Standard drug administration (recommended dose and infusion time) occurred in 74% (56/76) of patients on c-amB and 85% (33/39) on l-amB. In these 89 children, infusion-related reactions were similar for both c-amB and l-amB (23% (13/56) vs. 9% (3/33); P = 0.15); none occurred in children aged <90 days. There was no difference in amphotericin-associated glomerulotoxicity (c-amB 14% (8/56) vs. l-amB 21% (7/33); P = 0.40) or in the median maximum potassium requirements (c-amB 3.1 vs. l-amB 2.3 mmol kg-1 d-1 ; P = 0.29). Hepatotoxicity occurred more frequently with l-amB than c-amB (83% (24/29) vs. 56% (20/36); P = 0.032).
Conclusions: When appropriately administered, l-amB was associated with more hepatotoxicity than c-amB, with no difference in infusion-related reactions or nephrotoxicity. Differences in adverse effects between the preparations is not as marked in children as reported in adults.
Keywords: Amphotericin-B; adverse effects; antifungal; liposomal; paediatric.
© 2018 The British Pharmacological Society.
Similar articles
-
A prospective and retrospective analysis of the nephrotoxicity and efficacy of lipid-based amphotericin B formulations.Pharmacotherapy. 2001 Sep;21(9):1107-14. doi: 10.1592/phco.21.13.1107.34613. Pharmacotherapy. 2001. PMID: 11560200 Clinical Trial.
-
Effects of liposomal amphotericin B versus an amphotericin B lipid complex on liver histopathology in patients with hematologic malignancies and invasive fungal infections: a retrospective, nonrandomized autopsy study.Clin Ther. 2007 Sep;29(9):1980-6. doi: 10.1016/j.clinthera.2007.09.016. Clin Ther. 2007. PMID: 18035197
-
Comparison of nephrotoxicity associated to different lipid formulations of amphotericin B: a real-life study.Mycoses. 2015 Feb;58(2):104-12. doi: 10.1111/myc.12283. Epub 2015 Jan 15. Mycoses. 2015. PMID: 25590436
-
Amphotericin B formulations: a comparative review of efficacy and toxicity.Drugs. 2013 Jun;73(9):919-34. doi: 10.1007/s40265-013-0069-4. Drugs. 2013. PMID: 23729001 Review.
-
Deoxycholate amphotericin B and nephrotoxicity in the pediatric setting.Pediatr Infect Dis J. 2014 Aug;33(8):e198-206. doi: 10.1097/INF.0000000000000299. Pediatr Infect Dis J. 2014. PMID: 24618932 Review.
Cited by
-
Recent Challenges in Diagnosis and Treatment of Invasive Candidiasis in Neonates.Children (Basel). 2024 Sep 30;11(10):1207. doi: 10.3390/children11101207. Children (Basel). 2024. PMID: 39457172 Free PMC article. Review.
-
Polyene Antibiotics Physical Chemistry and Their Effect on Lipid Membranes; Impacting Biological Processes and Medical Applications.Membranes (Basel). 2022 Jun 30;12(7):681. doi: 10.3390/membranes12070681. Membranes (Basel). 2022. PMID: 35877884 Free PMC article. Review.
-
Pharmacovigilance study of amphotericin B for mucormycosis in post-COVID and non-COVID patients at a tertiary care hospital in Eastern India.Indian J Pharmacol. 2022 Nov-Dec;54(6):417-422. doi: 10.4103/ijp.ijp_474_22. Indian J Pharmacol. 2022. PMID: 36722553 Free PMC article.
-
Delivery strategies of amphotericin B for invasive fungal infections.Acta Pharm Sin B. 2021 Aug;11(8):2585-2604. doi: 10.1016/j.apsb.2021.04.010. Epub 2021 Apr 29. Acta Pharm Sin B. 2021. PMID: 34522599 Free PMC article. Review.
-
Nanotechnology-Based Approaches for Voriconazole Delivery Applied to Invasive Fungal Infections.Pharmaceutics. 2023 Jan 12;15(1):266. doi: 10.3390/pharmaceutics15010266. Pharmaceutics. 2023. PMID: 36678893 Free PMC article. Review.
References
-
- Dzierzanowska‐Fangrat K, Romanowska E, Gryniewicz‐Kwiatkowska O, Migdal M, Witulska K, Ryzko J, et al Candidaemia in a Polish tertiary paediatric hospital, 2000 to 2010. Mycoses 2014; 57: 105–109. - PubMed
-
- Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol 2006; 55: 809–818. - PubMed
-
- Richardson M, Lass‐Florl C. Changing epidemiology of systemic fungal infections. Clin Microbiol Infect 2008; 14 (Suppl. 4): 5–24. - PubMed
-
- Hamill RJ. Amphotericin B formulations: a comparative review of efficacy and toxicity. Drugs 2013; 73: 919–934. - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical