Liposomal amphotericin B (AmBisome) treatment of invasive fungal infections in immunocompromised children.

Abstract

Thirteen children were treated for 16 cases of proven (8 cases) or suspected (8 cases) invasive fungal infections caused by Candida spp. (9 cases), Aspergillus spp. (3 cases) and mycetoma (1 case). The type of fungal infection was not identified in 3 cases. Liposomal amphotericin B (AmBisome) was instituted because of the failure of previous treatments in 9 cases, toxicity-associated amphotericin B therapy in 4 cases and renal insufficiency in 3 cases. AmBisome was given for a median of 19 days (range 3-55) with a mean cumulative dose of 1.8 +/- 1.3 g (+/- SD). Acute toxic side-effects were not seen in any patients. Slight increases in serum creatinine were seen in 3 cases during AmBisome therapy. No other side-effects were observed. Among 8 cases with proven invasive fungal infection, 6 were clinically cured, one had persistent fungi and one died after only 3 days of AmBisome therapy. Eradication of fungi was documented in 5 out of 6 cases. Among the 8 cases with presumed fungal infections, 6 were clinically cured, one improved and one died after 6 days of treatment. To conclude, AmBisome can safely be given to children with invasive fungal infections; side-effects are minimal and among those treated for at least a week, the overall cure rate was 86% (12 out of 14).