Comparison of Effects and Side Effects of Amphotericin B Deoxycholate Infusion over 6 versus 24 Hours in Children with Cancer

Lee, Yong Jik; Kim, Yong Han; Hah, Jeong Ok

Abstract

PURPOSE
This study was performed to compare the effects and side effects of amphotericin B deoxycholate infusion over 6 versus 24 hours in febrile children with cancer. METHODS: Twenty-four children with cancer who were mostly neutropenic, febrile and suspected to have fungal infection and treated with amphotericin B deoxycholate from March 2001 to July 2002 at the Yeungnam University Hospital, Department of Pediatrics were enrolled for a cross-over study. All patients received 0.5 mg/kg amphotericin B deoxycholate infusion for average 7 days by two different infusion rates, one group by continuous infusion over 24 hours and the other by rapid infusion over 6 hours with at least 4 weeks of washout period. The side effects related to the infusion rates, fever, chilling or rigor, vomiting, headache, serum and urine electrolytes, beta2-microglobulin and creatinine clearance were monitored. The effect of amphotericin B deoxycholate infusion were studied by the days required for defervescence. RESULTS: There were no significant differences (P=0.11) in the effects between continuous and rapid infusion. But less side effects of chilling or rigor (P=0.01) were observed when amphotericin B deoxycholate was infused continuously. The serum phosphate (P=0.05) and magnesium (P=0.04) were lower and creatinine clearance was more reduced (P=0.01) when it was infused rapidly. CONCLUSION: Continuous infusion over 24 hours of amphotericin B deoxycholate could reduce the nephrotoxicity, such as hypophosphatemia, hypomagnesemia, low creatinine clearance and chilling reactions related to the rapid infusion without compromising the effects of amphotericin B deoxycholate in children with cancer.