LIPOSOMAL AMPHOTERICIN-B TREATMENT FOR NEONATAL FUNGAL-INFECTIONS

Background, Disseminated fungal infections are a major problem in high risk neonates, Conventional antifungal agents are often unsatisfactor y and haste a high incidence of severe adverse effects, Methods. We ad ministered liposomal encapsulated amphotericin B (AmBisome(R)), which is an alternative to conventional amphotericin B, to 40 preterm (mean birth weight, 1090 +/- 313.6 g; mean gestational age, 28.55 +/- 2.13 w eeks) and 4 full term (mean birth weight, 3080 +/- 118 g; mean gestati onal age, 39 +/- 0.7 weeks) newborn infants with a severe fungal infec tion, Results. Candida albicans was the most frequent fungus isolated. (70%). The duration of intravenous AmBisome(R) therapy ranged from 7 to 49 days; the cumulative dose ranged from 7 to 138.8 mg/kg (median, 45.2 mg/kg). Administration of AmBisome(R) was effective in 72.7% of p atients; 5 of 6 cases of meningitis also recovered; 63.6% of 33 very l ow birth weight infants survived. No side effects were observed, Concl usions. To our knowledge this is the largest est study of the treatmen t of neonates with liposomal amphotericin B, and the results confirm i ts effectiveness and safety, However, randomized clinical trials are r equired to establish the most effective administration protocol for Am Bisome(R), i.e. the starting dosage, the maximum effective dosage and the cumulative dosage, and to verify whether the preparation should be associated with another antifungal agent.