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Boletín Médico del Hospital Infantil de México

2006, Number 2

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Bol Med Hosp Infant Mex 2006; 63 (2)

Amphotericin B deoxycholate: conventional continuous infusion vs 24 h infusion in children with acute lymphocytic leukemia.

Nava-Ruiz A, Arbo-Sosa A

Language: Spanish
References: 27
Page: 84-93
PDF size: 105.15 Kb.


ABSTRACT

Introduction. Amphotericin B deoxycholate (Amp-d) remains the standard therapy for treatment of lifethreatening fungal infections in the immunocompromised host. However, Amp-d infusion is associated with significant toxicity. In adult population, a reduction in toxicity has been shown by a slower Amp-d infusion rate. Objective: to evaluate in an open comparative study the toxicity of Amp-d in children given as a continuous infusion versus conventional regimen over 6 hours.
Material and methods. Prospective, controlled, unblinded trial, which enrolled children with acute leukemia with suspected fungal infections and ranging from 1 to 18 years who were hospitalized in Hospital Infantil de Mexico. Amp-d was started as empiric therapy for persistent fever in the setting of neutropenia. Patients (Pts) were randomized to receive 1 mg/kg Amp-d by continuous infusion over 24 hours or 1 mg/kg over 6 hours. Pts were evaluated for side effects related to infusion and nefrotoxicity.
Results. Forty four Pts, mean age 10 ± 2 years, were included; 22 Pts were randomized to 24 hours infusion and 22 to 6 hours infusion (standard group). Baseline characteristics were not different for both groups. Fever, chills and rash related to Amp-d infusion were significantly more frequent on day 1 in standard group (77 vs 59%, 59 vs 36% and 36 vs 14%, respectively, P ‹0.05). An increase in serum creatinine (≥20%) in the course of treatment was observed in 17/22 of the Pts in the standard therapy group vs 6/22 of the Pts in the slow infusion group (P ‹0.01). Fifty percent of the Pts of standard group showed hypokalemia vs only 13% of the slow infusion group (P ‹0.01). At day 7 to 14, the mean creatinine clearance decreased in the therapy standard group 21 mL/m2/min vs 14 mL/m2/min in the continuous infusion group (P ‹0.05).
Conclusions. This study suggests that patients on continuous Amp-d 24 hours infusion regimen have fewer infusion related reactions and significantly reduced nefrotoxicity compared with those in the standard 6 hours infusion.


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