Liposomal amphotericin B (AmBisome) in children with febrile neutropenia and renal dysfunction

Purpose Lipid-based Amphotericin B preparations have been developed to impr ove drug targeting and reduce toxicity. Although increasingly used, little published information is available on liposomal Amphotericin B (AmBisome) i n children with established renal impairment on treatment for febrile neutr openia. The purpose of this study was to examine the nephrotoxicity of AmBi some in children with malignant disease with established renal impairment. Patients and Methods This retrospective study examined 17 episodes of AmBis ome use (3 mg/kg/day) in 14 febrile, neutropenic children with established glomerular or tubular impairment. The findings are contrasted with results from 25 episodes of Amphotericin B use (1 mg/kg/day) in 24 children with no rmal renal function receiving antifungal treatment for similar reasons. Results Mean creatinine was stable in patients receiving AmBisome but incre ased significantly in those on Amphotericin B. Doubling of serum creatinine was seen in no patient receiving AmBisome, in contrast to 20% of patients on Amphotericin B. In both groups mean serum potassium was stable but potas sium supplementation rose significantly. The rise in potassium supplementat ion became significant earlier in the Amphotericin B group than in the AmBi some group (day 2 vs. day 7). Despite the use of AmBisome, profound hypokal aemia (< 2.5 mmol/I) occurred in 18% of patients. Conclusions Further decline in glomerular function was rare in children wit h cancer receiving AmBisome. Potassium wasting was seen with both AmBisome and conventional Amphotericin B but in high-risk patients receiving AmBisom e deterioration was similar to that occurring in children with normal renal function receiving Amphotericin B.