Resumen

NAVA-RUIZ, Alejandra  y  ARBO-SOSA, Antonio. Amphotericin B deoxychocolate: conventional continuous infusion vs 24 infusion in children with acute lymphocytic leukemia. Bol. Med. Hosp. Infant. Mex. [online]. 2006, vol.63, n.2, pp.84-93. ISSN 1665-1146.

Introduction. Amphotericin B deoxycholate (Amp-d) remains the standard therapy for treatment of life-threatening fungal infections in the immunocompromised host. However, Amp-d infusion is associated with significant toxicity. In adult population, a reduction in toxicity has been shown by a slower Amp-d infusion rate. Objective: to evaluate in an open comparative study the toxicity of Amp-d in children given as a continuous infusion versus conventional regimen over 6 hours. Material and methods. Prospective, controlled, unblinded trial, which enrolled children with acute leukemia with suspected fungal infections and ranging from 1 to 18 years who were hospitalized in Hospital Infantil de Mexico. Amp-d was started as empiric therapy for persistent fever in the setting of neutropenia. Patients (Pts) were randomized to receive 1 mg/kg Amp-d by continuous infusion over 24 hours or 1 mg/kg over 6 hours. Pts were evaluated for side effects related to infusion and nefrotoxicity. Results. Forty four Pts, mean age 10 ± 2 years, were included; 22 Pts were randomized to 24 hours infusion and 22 to 6 hours infusion (standard group). Baseline characteristics were not different for both groups. Fever, chills and rash related to Amp-d infusion were significantly more frequent on day 1 in standard group (77 vs 59%, 59 vs 36% and 36 vs 14%, respectively, P < 0.05). An increase in serum creatinine (> 20%) in the course of treatment was observed in 17/22 of the Pts in the standard therapy group vs 6/22 of the Pts in the slow infusion group (P < 0.01). Fifty percent of the Pts of standard group showed hypokalemia vs only 13% of the slow infusion group (P < 0.01). At day 7 to 14, the mean creatinine clearance decreased in the therapy standard group 21 mL/m²/min vs 14 mL/m²/min in the continuous infusion group (P < 0.05). Conclusions. This study suggests that patients on continuous Amp-d 24 hours infusion regimen have fewer infusion related reactions and significantly reduced nefrotoxicity compared with those in the standard 6 hours infusion.

Palabras llave : Leukemia; acute; amphotericin B; fungus diseases; nefrotoxicity.