title: Short-course Regimens of Liposomal Amphotericin B for the Treatment of Mediterranean Visceral Leishmaniasis in Children: An 11-year Retrospective Study at a Tertiary Care Center.
abstract: BACKGROUND
  Visceral leishmaniasis (VL) remains an important public health problem in endemic regions. Current antileishmanial agents share several limitations including potentially serious side effects and the risk of clinical failure.
  
  
  OBJECTIVE
  Aim of this study was to examine the effectiveness and safety of short-course liposomal amphotericin B (L-AmB) regimens in the treatment of childhood VL in our area.
  
  
  METHODS
  The cases of 43 VL patients (20 males; 23 females; mean age: 4.6 years) treated at a tertiary children's hospital over an 11-year period were retrospectively reviewed. Diagnosis was confirmed with identification of Leishmania spp. in bone marrow samples and/or a positive serologic test. All patients were treated with 5 different L-AmB regimens at a dose of 18-22 mg/kg.
  
  
  RESULTS
  Initial response to treatment was attained in all patients (100%), while definitive cure at 6 months was achieved in 98% of patients. Adverse effects were recorded in 14 children and consisted mostly of infusion reactions and electrolyte disorders. Self-limiting nephrotoxicity was observed in 3 patients including a 12-year-old girl in whom acute kidney injury was developed. In addition, ventricular arrhythmias developed in a 13-year-old boy necessitating drug discontinuation. Although side effects were more frequent with the 2-day regimen, the difference with regard to toxicity between dosing regimens was not significant.
  
  
  CONCLUSIONS
  Short-course L-AmB regimens are effective and safe for the treatment of childhood VL in our area. Our findings suggest that large L-AmB doses can possibly account for a higher rate of adverse events including nephrotoxicity.
authors.affiliation: From the *Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Krepis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Argyri
authors.forename: Adamantia
authors.initials: A
authors.lastname: Krepi
authors.forename: Areti
authors.initials: A
authors.lastname: Syrmou
authors.forename: Nikos
authors.initials: N
authors.lastname: Spyridis
authors.forename: Maria
authors.initials: M
authors.lastname: Tsolia
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006115:Greece; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B