Safety, Tolerability, and Pharmacokinetics of Liposomal Amphotericin B in Immunocompromised Pediatric Patients



Seibel, NL, Shad, AT, Bekersky, I, Groll, AH, Gonzalez, C, Wood, LV, Jarosinski, P, Buell, D, Hope, WW ORCID: 0000-0001-6187-878X and Walsh, TJ
(2017) Safety, Tolerability, and Pharmacokinetics of Liposomal Amphotericin B in Immunocompromised Pediatric Patients. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 61 (2). e01477-e01416.

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Abstract

The safety, tolerability, and pharmacokinetics of the liposomal formulation of amphotericin B (L-AMB) were evaluated in 40 immunocompromised children and adolescents. The protocol was an open-label, sequential-dose-escalation, multidose pharmacokinetic study with 10 to 13 patients in each of the four dosage cohorts. Each cohort received daily dosages of 2.5, 5.0, 7.5, or 10 mg of amphotericin B in the form of L-AMB per kg of body weight. Neutropenic patients between the ages of 1 and 17 years were enrolled to receive empirical antifungal therapy or treatment of documented invasive fungal infections. The pharmacokinetic parameters of L-AMB were measured as those of amphotericin B by high-performance liquid chromatography and calculated by noncompartmental methods. There were nine adverse-event-related discontinuations, four of which were related to infusions. Infusion-related side effects occurred for 63 (11%) of 565 infusions, with 5 patients experiencing acute infusion-related reactions (7.5- and 10-mg/kg dosage levels). Serum creatinine levels increased from 0.45 ± 0.04 mg/dl to 0.63 ± 0.06 mg/dl in the overall population (P = 0.003), with significant increases in dosage cohorts receiving 5.0 and 10 mg/kg/day. At the higher dosage level of 10 mg/kg, there was a trend toward greater hypokalemia and vomiting. The area under the concentration-time curve from 0 to 24 h (AUC<sub>0-24</sub>) values for L-AMB on day 1 increased from 54.7 ± 32.9 to 430 ± 566 μg · h/ml in patients receiving 2.5 and 10.0 mg/kg/day, respectively. These findings demonstrate that L-AMB can be administered to pediatric patients at dosages similar to those for adults and that azotemia may develop, especially in those receiving ≥5.0 mg/kg/day.

Item Type: Article
Uncontrolled Keywords: antimicrobial safety and tolerability, hematological malignancies, liposomal amphotericin B, pediatrics, pharmacokinetics
Depositing User: Symplectic Admin
Date Deposited: 23 Mar 2017 08:01
Last Modified: 13 Feb 2024 14:03
DOI: 10.1128/AAC.01477-16
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3006561