166. A Comparison of Amphotericin B Deoxycholate (D-AMB) versus Liposomal Amphotericin B (L-AMB) in Neonates: Is Newer Better?
Session: Poster Abstract Session: Antimicrobial Use in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID 2013 poster ampho peds simplify 09192013.pdf (199.9 kB)
  • Background:

    Nephrotoxicity (NT) associated with D-AMB use is well documented in adults and occurs less frequently with the lipid formulations of amphotericin B (AMB).  However, the incidence of NT associated with the various AMB products used in neonates (NEO) is poorly defined. The reported incidence of NT associated with AMB use in NEO ranges from 0-60%. The purpose of this study was to evaluate NT associated with D-AMB and L-AMB use in NEO.

    Methods:

    This is a retrospective analysis of NEO receiving at least one dose of either D-AMB or L-AMB at a single center between 1999 and 2010. Demographics including gestational age, birth weight, Apgar score at 1 min, and baseline Scr were evaluated. NEO with a baseline Scr > 1 mg/dL were excluded from this analysis. NT was defined as urine output <1 mL/kg/hr, or an increase in SCr> = 0.3 mg/dL, or an increase in Scr > = 50% from baseline.

    Results:

    94 NEO received either D-AMB or L-AMB during the study period; 75 met the inclusion criteria. From 1999-2006, only 12/60 (21%) of all AMB products prescribed were L-AMB, whereas from 2006-2010, this had increased to 13/15 (87%). 54/75 (72%) NEO were premature with extremely low birth weight. Baseline characteristics were not different between D-AMB and L-AMB groups. No difference was found in NT defined by any of the previously described criteria. Incidence of NT ranged from 16% to 28%. Four NEO switched to L-AMB due to NT. All NEO had resolution of NT defined by returning to baseline renal function. No significant difference was found in daily fluid intake between D-AMB (141±16 ml/kg/day) and L-AMB (137±5ml/kg/day). Candida spp was isolated in 17/50 (34%) of the case in D-AMB group and 10/25 (40%) of the case in L-AMB group.

    Conclusion:

    Regardless of definition for renal dysfunction we did not find a difference in the incidence of NT between D-AMB and L-AMB in our population. Interestingly, similar to other recent reports in the US and Europe we noticed a trend for the increased use of the L-AMB compared to D-AMB. From previous reports and our data it would seem that increased L-AMB has occurred without evidence of increased efficacy or safety. The use of L-AMB instead of D-AMB to prevent NT in NEO seems unwarranted.

    Siyun Liao, Pharm.D., Ph.D.1, Zahra Kassamali, PharmD2, Donna Kraus, Pharm.D.3, Robert Glowacki, PharmD4 and Larry H. Danziger, Pharm.D.3, (1)University of Illinois, Chicago, IL, (2)University of Illinois, Chicago, Chicago, IL, (3)University of Illinois at Chicago, Chicago, IL, (4)University of Illinois at Chicago, College of Pharmacy, Chicago, IL

    Disclosures:

    S. Liao, None

    Z. Kassamali, None

    D. Kraus, None

    R. Glowacki, None

    L. H. Danziger, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.