Pancreatic toxicity after liposomal amphotericin B

Area of Science:

• Pediatric Infectious Diseases
• Pharmacology
• Gastroenterology

Background:

• Liposomal amphotericin B (LAB) is available in Germany but its pediatric safety and efficacy are not well-documented.
• Gastrointestinal side effects like elevated alkaline phosphatase and transaminases have been reported.
• LAB is used for treating and preventing fungal infections in pediatric patients, including those undergoing chemotherapy.

Purpose of the Study:

• To investigate the safety profile of liposomal amphotericin B in pediatric patients.
• To identify and document potential adverse effects of LAB therapy in children.
• To assess the incidence of elevated serum lipase levels and pancreatitis associated with LAB treatment.

Main Methods:

• Retrospective analysis of 31 pediatric patients treated with liposomal amphotericin B between 1994 and 1999.
• Dose regimens included 1-3 mg/kg/day for treatment and 1 mg/kg three times weekly for prophylaxis.
• Monitoring for adverse events, including gastrointestinal side effects and serum lipase levels.

Main Results:

• Five patients experienced isolated, transient elevations in serum lipase levels during or shortly after LAB therapy.
• Three of these patients exhibited clinical signs of pancreatitis.
• One patient with pancreatitis also showed slightly elevated transaminases.

Conclusions:

• Elevated serum lipase levels may be an unreported side effect of liposomal amphotericin B in children.
• The pathogenesis of lipase elevation is unclear, with potential causes including enzyme induction or direct toxicity.
• Further research is needed to elucidate the mechanism and clinical significance of this finding.