CANDIDA INFECTION IN VERY-LOW-BIRTH-WEIGHT INFANTS - OUTCOME AND NEPHROTOXICITY OF TREATMENT WITH LIPOSOMAL AMPHOTERICIN-B (AMBISOME(R))

Systemic fungal infection occurs in 2 to 4.5% of very low birth-weight (VLBW) infants (<1,500 g) and may be fatal in 25 to 54%.-Candida sp. is the major pathogen and amphotericin B the treatment of choice. To r educe side effects and optimize drug action, a formulation of amphoter icin B encapsulated in liposomes (AmBisome((R))) has been introduced. Data on 21 VLBW infants who received a full course of AmBisome((R)) wa s collected and its toxic effects with emphasis on nephrotoxicity and hypokalemia assessed. The median gestational age was 25 weeks (range 2 3-31) with a median birth-weight of 730 g (range 450-1,370). Antifunga l therapy was started at a median age of 13 days (range 1-49). The med ian dose given was 2.6 mg/kg/day (range 1-5), and the median duration of therapy was 28 days (range 11-79), corresponding to a median cumula tive dose of 71 mg/kg (range 12-271). Hypokalemia (<3.0 mmol/l) was ob served in 30% before, and 15% during AmBisome((R)) treatment. Twenty-o ne days after the termination of therapy, hypokalemia was not present in any patient. Median maximum daily potassium supplementation did not exceed doses usually recommended for VLBW infants. The median of the maximum creatinine levels before treatment was 121 mu mol/l (range 71- 221) and fell to 68 mu mol/l (range 31-171) during treatment and 46 mu mol/l (range 26-62) 21 days after the termination of therapy. All pat ients treated with AmBisome((R)) eradicated fungi and recovered clinic ally. AmBisome showed no certain nephrotoxicity in VLBW infants in thi s study.