title: Amphotericin B serum levels in pediatric bone marrow transplant recipients.
abstract: 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.
authors.affiliation: St Anna Children's Hospital, Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Emminger
authors.forename: H R
authors.initials: HR
authors.lastname: Lang
authors.forename: W
authors.initials: W
authors.lastname: Emminger-Schmidmeier
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: H
authors.initials: H
authors.lastname: Gadner
mesh_terms: 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
chemical_list: D000666:Amphotericin B