Krepis Panagiotis, Argyri Ioanna, Krepi Adamantia, Syrmou Areti, Spyridis Nikos, Tsolia Maria
From the *Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Pediatr Infect Dis J. 2017 Sep;36(9):849-854. doi: 10.1097/INF.0000000000001602.
BACKGROUND: Visceral leishmaniasis (VL) remains an important public health problem in endemic regions. Current antileishmanial agents share several limitations including potentially serious side effects and the risk of clinical failure. OBJECTIVES: Aim of this study was to examine the effectiveness and safety of short-course liposomal amphotericin B (L-AmB) regimens in the treatment of childhood VL in our area. METHODS: The cases of 43 VL patients (20 males; 23 females; mean age: 4.6 years) treated at a tertiary children's hospital over an 11-year period were retrospectively reviewed. Diagnosis was confirmed with identification of Leishmania spp. in bone marrow samples and/or a positive serologic test. All patients were treated with 5 different L-AmB regimens at a dose of 18-22 mg/kg. RESULTS: Initial response to treatment was attained in all patients (100%), while definitive cure at 6 months was achieved in 98% of patients. Adverse effects were recorded in 14 children and consisted mostly of infusion reactions and electrolyte disorders. Self-limiting nephrotoxicity was observed in 3 patients including a 12-year-old girl in whom acute kidney injury was developed. In addition, ventricular arrhythmias developed in a 13-year-old boy necessitating drug discontinuation. Although side effects were more frequent with the 2-day regimen, the difference with regard to toxicity between dosing regimens was not significant. CONCLUSIONS: Short-course L-AmB regimens are effective and safe for the treatment of childhood VL in our area. Our findings suggest that large L-AmB doses can possibly account for a higher rate of adverse events including nephrotoxicity.
背景:内脏利什曼病(VL)在流行地区仍然是一个重要的公共卫生问题。目前的抗利什曼原虫药物存在一些局限性,包括潜在的严重副作用和临床治疗失败的风险。 目的:本研究旨在探讨短疗程脂质体两性霉素B(L-AmB)方案治疗本地区儿童VL的有效性和安全性。 方法:回顾性分析一家三级儿童医院在11年期间治疗的43例VL患者(男20例,女23例;平均年龄:4.6岁)的病例。通过在骨髓样本中鉴定利什曼原虫属和/或血清学检测呈阳性来确诊。所有患者均接受5种不同的L-AmB方案治疗,剂量为18-22mg/kg。 结果:所有患者(100%)均获得初始治疗反应,98%的患者在6个月时实现彻底治愈。14名儿童出现不良反应,主要为输液反应和电解质紊乱。3例患者出现自限性肾毒性,其中包括一名12岁女孩,她发展为急性肾损伤。此外,一名13岁男孩出现室性心律失常,需要停药。虽然2天疗程的副作用更频繁,但给药方案之间的毒性差异不显著。 结论:短疗程L-AmB方案治疗本地区儿童VL有效且安全。我们的研究结果表明,大剂量L-AmB可能导致包括肾毒性在内的更高不良事件发生率。
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