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Nephrotoxicity associated with amphotericin B deoxycholate in neonates.
Jennifer Le1, Felice C Adler-Shohet, Christine Nguyen
1Division Pharmacy Practice and Administration, Western University of Health Sciences, College of Pharmacy, Pomona, CA 91766-1854, USA. jle@westernu.edu
The Pediatric Infectious Disease Journal
|November 26, 2009
Summary
Amphotericin B deoxycholate (amphoB) rarely causes lasting kidney damage in newborns. Close monitoring of renal function and potassium is recommended during amphoB treatment.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Infectious Diseases
Background:
- Nephrotoxicity from amphotericin B deoxycholate (amphoB) in neonates is poorly understood, with conflicting reports on its prevalence.
- Existing literature shows a wide range of reported amphoB-associated nephrotoxicity in neonates, from minimal to as high as 85%.
Purpose of the Study:
- To define the prevalence of nephrotoxicity in neonates treated with amphotericin B deoxycholate.
- To evaluate the association between amphoB therapy and renal function in infants.
Main Methods:
- Retrospective review of medical records for infants under 90 days old who received at least 3 doses of amphoB.
- Data collection included demographics, treatments, microbiology, and laboratory results, with nephrotoxicity defined as a serum creatinine rise of ≥0.4 mg/dL.
Main Results:
- Out of 92 infants, 15% experienced nephrotoxicity and 17% developed hypokalemia.
- No significant differences in risk factors (gestational age, birth weight, co-medications) were found between infants with and without nephrotoxicity.
- Elevated serum creatinine levels resolved in all but one infant by the end of amphoB therapy.
Conclusions:
- Amphotericin B deoxycholate treatment does not appear to cause persistent nephrotoxicity in neonates.
- Close monitoring of infant renal function and potassium levels is crucial during amphoB therapy due to potential transient changes.
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