High Dose of Amphotericin B in Intralipid Emulsion-based Delivery System in Immunocompromised Children with Invasive Fungal Infections

ABSTRACT

PURPOSE: Fungal infections are an important cause of morbidity and mortality in patients with hematologic malignancies. The therapy of choice in documented or suspected invasive fungal infections has been intravenous Amphotericin B (AmB). Adverse effects such as fever, chils, thrombophlebitis, nausea or vomiting are common. A more serious adverse effect is potential renal impairment. As AmB administration mixed with Intralipid (AmB/Intralipid) was reported to decrease AmB toxicity without a concomitant loss of antifungal efficacy, we studied the efficacy and side effects of long-term administration of AmB/Intralipid in leukemic children with invasive fungal diseases. METHODS: AmB/Intralipid was administered in seven leukemic children (male, 3; female, 4) who had invasive fungal infections between July 1994 and March 1997. RESULTS: AmB/Intralipid was administered at a mean concentration of 1.45mg/kg/day for a mean of 58.1 days with cumulative dose of 3.01g. Excluding 2 patients who succumbed to the underlying leukemia, 4 out of 5 remaining patients remained free of both fungal infection and leukemia. Chills associated with AmB/Intralipid were found 13 times in 4 patients. One patient could not continue the administration because of the chills on the 45th day of AmB/Intralipid. Renal and hepatic impairment greater than Grade II toxicity was found in each case, respectively. The other 6 patients showed mild elevation from the baseline, but remained within the normal limits. CONCLUSION: Long-term, high-dose AmB/Intralipid therapy can be safely and effectively used in immunocompromised children with invasive fungal infections.