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[Advantages and drawbacks of amphotericin formulations in children: literature review]

David F Bes1, Norma Sberna, María Teresa Rosanova

  • 1Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. davidfbes@hotmail.com

Archivos Argentinos De Pediatria
|February 7, 2012
PubMed

Insights

Amphotericin B is a standard antifungal for serious fungal infections but causes side effects. Lipid formulations offer improved safety but raise cost and pediatric use questions.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Context:

  • Rising incidence of fungal infections and expanded species range, particularly in immunocompromised individuals.
  • Amphotericin B has been a cornerstone antifungal therapy for decades.
  • Conventional Amphotericin B is associated with significant infusion-related toxicities and dose-limiting nephrotoxicity.

Purpose:

  • To review the role of Amphotericin B in treating life-threatening fungal infections.
  • To discuss the approved lipid formulations of Amphotericin B and their improved therapeutic index.
  • To address existing questions regarding pediatric use, cost-effectiveness, and indications for lipid formulations.

Summary:

  • Despite lack of high-quality comparative pediatric studies, all four Amphotericin B preparations are considered similarly effective.
  • Lipid formulations enhance the therapeutic index, mitigating nephrotoxicity associated with conventional Amphotericin B.
  • High costs of lipid formulations are a barrier, but renal toxicity must be factored into cost-benefit analyses.

Impact:

  • Provides a concise overview of Amphotericin B's clinical utility and limitations.
  • Highlights the therapeutic advantages and economic considerations of lipid formulations.
  • Informs clinical decision-making, especially in the pediatric setting, balancing efficacy, safety, and cost.

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