Deoxycholate amphotericin B and nephrotoxicity in the pediatric setting

Area of Science:

• Pediatric Mycology
• Pharmacology
• Infectious Diseases

Background:

• Pediatric mycotic infections have rising morbidity and mortality, particularly in immunocompromised children.
• Conventional amphotericin B (deoxycholate amphotericin B) poses nephrotoxicity risks in pediatric patients beyond neonates.
• Lipid-associated amphotericin B formulations show promise but comparative nephrotoxicity data in children remain controversial.

Purpose of the Study:

• To evaluate the risks and benefits of different amphotericin B formulations in pediatric patients.
• To inform cost-effective treatment strategies for pediatric mycotic infections, especially in resource-limited regions.
• To highlight the need for further research into pediatric pharmacokinetics and nephroprotective measures.

Main Methods:

• Review of existing literature on amphotericin B formulations in pediatric populations.
• Analysis of comparative efficacy and nephrotoxicity data for deoxycholate, liposomal, and lipid complex amphotericin B.
• Consideration of economic factors and kidney-protective strategies.

Main Results:

• Guidelines favor lipid formulations for pediatric polyene antifungal therapy due to reduced nephrotoxicity compared to conventional amphotericin B.
• High costs of lipid formulations limit their use in economically disadvantaged areas.
• Adjuvant sodium supplementation may protect kidney function in very low birth weight infants.

Conclusions:

• Treatment decisions for pediatric mycotic infections require balancing drug efficacy, nephrotoxicity, cost, and patient-specific factors.
• Conventional amphotericin B with kidney protection is a viable option for empiric treatment.
• Lipid formulations should be reserved for specific pediatric cases, and low-cost, kidney-sparing deoxycholate amphotericin B treatments require further investigation.