Higuchi R, Kusumoto S, Ban H, Iwahashi S, Kobayashi M, Sumiyama K, Koike M
Department of Pediatrics, Wakayama Medical College, Japan.
Acta Paediatr Jpn. 1993 Jun;35(3):238-42. doi: 10.1111/j.1442-200x.1993.tb03044.x.
We introduced continuous intravenous infusion of amphotericin-B (AMPH-B) to extremely low birthweight (ELBW) infants (< 1000 g) with or without renal failure as a single agent for treating definite or probable systemic candidiasis. The species of Candida isolated from blood or tracheal aspirate or urine were C. albicans in seven infants, C glabrata in two, C. tropicalis in one and C. parapsilosis in one. The minimal inhibitory concentrations (MIC) of AMPH-B required against these isolates were less than 0.2 micrograms/mL except for that against one strain of C. albicans (0.78 microgram/mL). Serum AMPH-B levels were 0.31-0.78 (0.51 +/- 0.14) micrograms/mL when doses of 0.2-0.55 (0.32 +/- 0.11) mg/kg per day were being administered. The serum level was higher than the MIC of each isolate in all but one infant who died of disseminated intravascular coagulation and Candida pneumonia. Another infant died of congenital heart disease. The other nine infants survived. The serum level showed no correlation with the daily dose. The ratio of the serum level to the daily dose (L/D ratio) showed a significant correlation to serum creatinine (r = 0.787) and the linear regression curve followed the equation: L/D ratio = 0.223 x serum creatinine + 1.11 (P < 0.01). Few adverse effects due to AMPH-B were noted. Our data may give a simple reference to serum AMPH-B levels during continuous intravenous infusion from the dose and the serum creatinine level.
我们对患有或未患肾衰竭的极低出生体重（ELBW）婴儿（<1000g）采用两性霉素B（AMPH - B）持续静脉输注作为单一药物治疗确诊或疑似的全身性念珠菌病。从血液、气管吸出物或尿液中分离出的念珠菌种类，7例婴儿为白色念珠菌，2例为光滑念珠菌，1例为热带念珠菌，1例为近平滑念珠菌。除一株白色念珠菌（0.78微克/毫升）外，AMPH - B对这些分离株的最小抑菌浓度（MIC）均小于0.2微克/毫升。当每日剂量为0.2 - 0.55（0.32±0.11）毫克/千克时，血清AMPH - B水平为0.31 - 0.78（0.51±0.14）微克/毫升。除一名死于弥散性血管内凝血和念珠菌肺炎的婴儿外，所有婴儿的血清水平均高于各分离株的MIC。另一名婴儿死于先天性心脏病。其他9名婴儿存活。血清水平与每日剂量无相关性。血清水平与每日剂量的比值（L/D比值）与血清肌酐呈显著相关（r = 0.787），线性回归曲线符合方程：L/D比值 = 0.223×血清肌酐 + 1.11（P < 0.01）。未观察到因AMPH - B引起的不良反应。我们的数据可为持续静脉输注期间根据剂量和血清肌酐水平估算血清AMPH - B水平提供一个简单的参考。
