title: Liposomal amphotericin B in critically ill paediatric patients.
abstract: OBJECTIVE
  Literature provides much evidence regarding liposomal amphotericin B treatment for fungal infections in neonates and infants. Relevant data regarding critically ill paediatric patients of older age are scarce. We aimed to present our experience regarding liposomal amphotericin B use in critically ill paediatric patients from a tertiary-care paediatric hospital in Athens, Greece.
  
  
  METHODS
  We prospectively identified all paediatric patients who received treatment with liposomal amphotericin B in the intensive care unit of a tertiary-care paediatric hospital during a 3-year period (2005-2008). Data were retrieved from the evaluation of the available medical records.
  
  
  CONCLUSIONS
  Twenty-three (nine females, mean age: 26·4 months, range: 5-39 months) critically ill paediatric patients were included; 12 had malignancy. In 16 of the 23 included children, liposomal amphotericin B was administered for the treatment of confirmed fungal infections (all but one were invasive), whereas in seven patients, it was used as pre-emptive treatment. One patient received voriconazole concomitantly. Eleven of the 16 children with documented infections were cured; five improved. Six of the seven children who received pre-emptive treatment also showed clinical improvement. Nine deaths were noted, all attributed to underlying diseases. Two cases of hepatotoxicity and one case of nephrotoxicity (all leading to drug-discontinuation) occurred. Seven and five cases of mild reversible hypokalaemia and hyponatraemia, respectively, were also noted.
  
  
  CONCLUSIONS
  According to the findings of our small case series, liposomal amphotericin B may provide a useful treatment option for fungal infections of vulnerable critically ill paediatric patients with considerable comorbidity.
authors.affiliation: Pediatric Intensive Care Unit, P. & A. Kyriakou Children's Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Sideri
authors.forename: M E
authors.initials: ME
authors.lastname: Falagas
authors.forename: M
authors.initials: M
authors.lastname: Grigoriou
authors.forename: E K
authors.initials: EK
authors.lastname: Vouloumanou
authors.forename: J H
authors.initials: JH
authors.lastname: Papadatos
authors.forename: E
authors.initials: E
authors.lastname: Lebessi
authors.forename: D A
authors.initials: DA
authors.lastname: Kafetzis
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002675:Child, Preschool; D015897:Comorbidity; D016903:Drug Monitoring; D005260:Female; D006115:Greece / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D007010:Hyponatremia / Q000139:chemically induced; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008081:Liposomes; D008297:Male; D009181:Mycoses / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D009369:Neoplasms / Q000453:epidemiology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced
chemical_list: D000935:Antifungal Agents; D008081:Liposomes; D000666:Amphotericin B