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Liposomal amphotericin B treatment for neonatal fungal infections
A Scarcella1, M B Pasquariello, B Giugliano
1Department of Pediatrics, University of Naples Federico II, Italy.
Background:
Disseminated fungal infections are a major problem in high risk neonates. Conventional antifungal agents are often unsatisfactory and have a high incidence of severe adverse effects.
Methods:
We administered liposomal encapsulated amphotericin B (AmBisome), which is an alternative to conventional amphotericin B, to 40 preterm (mean birth weight, 1090 +/- 313.6 g; mean gestational age, 28.35 +/- 2.13 weeks) and 4 full term (mean birth weight, 3080 +/- 118 g; mean gestational age, 39 +/- 0.7 weeks) newborn infants with a severe fungal infection.
Results:
Candida albicans was the most frequent fungus isolated (70%). The duration of intravenous AmBisome therapy ranged from 7 to 49 days; the cumulative dose ranged from 7 to 138.8 mg/kg (median, 45.2 mg/kg). Administration of AmBisome was effective in 72.7% of patients; 5 of 6 cases of meningitis also recovered; 63.6% of 33 very low birth weight infants survived. No side effects were observed.
Conclusions:
To our knowledge this is the largest study of the treatment of neonates with liposomal amphotericin B, and the results confirm its effectiveness and safety. However, randomized clinical trials are required to establish the most effective administration protocol for AmBisome, i.e. the starting dosage, the maximum effective dosage and the cumulative dosage, and to verify whether the preparation should be associated with another antifungal agent.
Insights
Liposomal amphotericin B (AmBisome) effectively treated severe fungal infections in high-risk neonates, showing a 72.7% success rate with no observed side effects. Further trials are needed to optimize treatment protocols for this vulnerable population.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Disseminated fungal infections pose significant risks to high-risk neonates.
- Conventional antifungal therapies often yield unsatisfactory outcomes and severe adverse effects.
Purpose of the Study:
- To evaluate the efficacy and safety of liposomal encapsulated amphotericin B (AmBisome) in treating severe fungal infections in newborn infants.
Main Methods:
- Liposomal encapsulated amphotericin B (AmBisome) was administered to 40 preterm and 4 full-term neonates with severe fungal infections.
- Treatment duration varied from 7 to 49 days, with cumulative doses ranging from 7 to 138.8 mg/kg.
Main Results:
- Candida albicans was the most common pathogen (70%).
- AmBisome demonstrated effectiveness in 72.7% of patients, including 5 of 6 meningitis cases.
- Survival rates were 63.6% for very low birth weight infants, with no observed side effects.
Conclusions:
- Liposomal amphotericin B (AmBisome) is a safe and effective treatment for neonatal fungal infections.
- Randomized clinical trials are necessary to determine optimal AmBisome dosing and potential combination therapies.