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Amphotericin-induced heart-rate decrease in children
M Levy1, J Domaratzki, G Koren
1Division of General Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Amphotericin B can cause significant, acute heart rate drops in children, sometimes leading to early treatment discontinuation. Healthcare providers should monitor for this serious adverse effect during therapy.
Area of Science:
- Pediatric Pharmacology
- Cardiovascular Toxicology
- Antifungal Drug Adverse Effects
Background:
- Amphotericin B is a critical antifungal agent used in pediatric medicine.
- Adverse reactions to Amphotericin B can impact patient management and outcomes.
- Understanding drug-induced cardiovascular effects is crucial for patient safety.
Purpose of the Study:
- To describe and analyze acute decreases in heart rate associated with Amphotericin B administration in pediatric patients.
- To identify the incidence and characteristics of this specific adverse event.
- To compare patients experiencing heart rate drops with those who did not.
Main Methods:
- Retrospective case series describing six pediatric patients with acute heart rate decreases during Amphotericin B therapy.
- Comparison of affected patients with six age-matched controls who received Amphotericin B without this reaction.
- Analysis of heart rate changes, timing of the reaction, and duration of therapy.
Main Results:
- Six of 90 pediatric patients (6.7%) experienced acute, significant heart rate drops (mean from 104 to 62 bpm) temporally related to Amphotericin B.
- The reaction occurred between day 3 and day 7 of therapy and persisted throughout infusions and for hours after.
- Patients with heart rate drops received Amphotericin B for a significantly shorter duration (4.6 days) compared to controls (12.6 days).
Conclusions:
- Acute bradycardia is a potential, serious adverse effect of Amphotericin B in children.
- This adverse event may necessitate early discontinuation of Amphotericin B therapy.
- Awareness of this effect is vital for clinicians, especially in vulnerable pediatric patients.
Abstract:
We describe six children with acute decreases in heart rate temporally related to amphotericin B administration. All patients had achieved their maximal dose within 3 to 4 days. Heart-rate drops occurred as early as day 3 but could be delayed up to day 7 after start of therapy. The mean heart rate dropped from 104 +/- 8/min (range 96 to 114) to 62 +/- 8/min (range 48 to 72) (P = 0.0001). A slower heart rate than baseline was noted during the entire duration of drug administration, from 60 minutes of starting the infusion to 220 minutes (mean 120 +/- 40) after discontinuation of the infusion. This reaction was noted in six of 90 (6.7%) patients who had amphotericin. These six children were compared with six age-matched children who received the drug but in whom such changes in heart rate did not develop. The method of administration of amphotericin B was similar in both patients and controls, starting with 0.25 mg/kg/day and increasing by 0.25 mg/kg/day up to 1 mg/kg/day. Children with heart-rate drop received amphotericin for 4.6 +/- 1.8 days, significantly shorter than their controls (12.6 +/- 6.9 days) (P = 0.02), suggesting that this adverse effect has led to early discontinuation of amphotericin therapy. Physicians and nurses caring for children receiving amphotericin B should be aware of this potential adverse effect, which can be serious in a patient with an underlying heart condition or in a patient who is already on heart-rate-lowering drugs.