Amphotericin B serum levels in pediatric bone marrow transplant recipients.
We studied amphotericin B (AMB) serum levels (n = 590) in 41 pediatric patients, who underwent allogeneic (21) or autologous (20) bone marrow transplantation (BMT). All patients received AMB orally as part of a total gut decontamination; 30/41 patients (73%) had AMB i.v. either for prophylaxis or therapy of fungal infections. Rapid initial dose escalation of AMB and the infusion over 1 h only were well tolerated by the children. Serum level monitoring allowed AMB long-term treatment safely to be administered in children suffering from transplantation-related complications (veno-occlusive disease of the liver, graft-versus-host disease of the liver). An h.p.l.c. method was used for monitoring AMB serum trough levels to avoid levels exceeding 2 mg/l. One lethal fungal infection was observed in 41 pediatric BMT recipients (2.4%). Rapidly increasing doses of AMB at start of therapy and drug monitoring by h.p.l.c. might help to reduce fungal mortality and renal toxicity by a dose sparing effect in BMT recipients.
Emminger
W
W
St Anna Children's Hospital, Vienna, Austria.
Lang
H R
HR
Emminger-Schmidmeier
W
W
Peters
C
C
Gadner
H
H
D000284:Administration, Oral; D000293:Adolescent; D000666:Amphotericin B / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects; D009181:Mycoses / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D014184:Transplantation, Homologous
D000666:Amphotericin B