Weitkamp J H, Poets C F, Sievers R, Musswessels E, Groneck P, Thomas P, Bartmann P
Abteilung für Neonatologie, Universität Bonn, Germany.
Infection. 1998 Jan-Feb;26(1):11-5. doi: 10.1007/BF02768745.
Systemic fungal infection occurs in 2 to 4.5% of very low birth-weight (VLBW) infants (< 1,500 g) and may be fatal in 25 to 54%. Candida sp. is the major pathogen and amphotericin B the treatment of choice. To reduce side effects and optimize drug action, a formulation of amphotericin B encapsulated in liposomes (AmBisome) has been introduced. Data on 21 VLBW infants who received a full course of AmBisome was collected and its toxic effects with emphasis on nephrotoxicity and hypokalemia assessed. The median gestational age was 25 weeks (range 23-31) with a median birth-weight of 730 g (range 450-1,370). Antifungal therapy was started at a median age of 13 days (range 1-49). The median dose given was 2.6 mg/kg/day (range 1-5), and the median duration of therapy was 28 days (range 11-79), corresponding to a median cumulative dose of 71 mg/kg (range 12-271). Hypokalemia (< 3.0 mmol/l) was observed in 30% before, and 15% during AmBisome treatment. Twenty-one days after the termination of therapy, hypokalemia was not present in any patient. Median maximum daily potassium supplementation did not exceed doses usually recommended for VLBW infants. The median of the maximum creatinine levels before treatment was 121 mumol/l (range 71-221) and fell to 68 mumol/l (range 31-171) during treatment and 46 mumol/l (range 26-62) 21 days after the termination of therapy. All patients treated with AmBisome eradicated fungi and recovered clinically. AmBisome showed no certain nephrotoxicity in VLBW infants in this study.
极低出生体重（VLBW，<1500克）婴儿中，系统性真菌感染的发生率为2%至4.5%，其中25%至54%可能致命。念珠菌属是主要病原体，两性霉素B是首选治疗药物。为减少副作用并优化药物作用，已引入脂质体包裹的两性霉素B制剂（安必素）。收集了21例接受完整疗程安必素治疗的极低出生体重婴儿的数据，并评估了其毒性作用，重点是肾毒性和低钾血症。中位胎龄为25周（范围23 - 31周），中位出生体重为730克（范围450 - 1370克）。抗真菌治疗开始的中位年龄为13天（范围1 - 49天）。给予的中位剂量为2.6毫克/千克/天（范围1 - 5），中位治疗持续时间为28天（范围11 - 79天），相应的中位累积剂量为71毫克/千克（范围12 - 271）。在使用安必素治疗前，30%的患者出现低钾血症（<3.0毫摩尔/升），治疗期间为15%。治疗结束21天后，所有患者均未出现低钾血症。最大每日钾补充量的中位数未超过通常推荐给极低出生体重婴儿的剂量。治疗前肌酐水平最大值的中位数为121微摩尔/升（范围71 - 221），治疗期间降至68微摩尔/升（范围31 - 171），治疗结束21天后降至46微摩尔/升（范围26 - 62）。所有接受安必素治疗的患者均根除了真菌且临床康复。在本研究中，安必素对极低出生体重婴儿未显示出明显的肾毒性。
