Renal Impairment Related to Different Antifungal Medications in Cases of Invasive Candida Infections in Tawam Hospital Pediatric Population between 2008-2015

Abstract

Background:

As a tertiary hospital, Tawam Hospital has been dealing with more and more complex pediatric cases. Such cases are often at higher risk of developing Invasive Candida Infections (ICI). Amphotericin B preparations continued to provide the widest coverage for all Candida strains and have been the drug of choice for definitive and empirical therapy in our institute. However, renal complications have always been a concern with this group of antifungals. Numerous studies have reported contradicting results in terms of which Amphotericin B preparation has less renal side effects. Therefore, we are here to report our own experience.

Methods:

We performed a retrospective cohort study of all children (15 years and younger) with ICI who were treated at Tawam Hospital from 2008 to 2015.

 

Results:

Out of the 40 patients included in this study, 7 patients were treated with Amphotericin B Liposomal (ABL). Two of them had elevated Urea/Creatinine after initiating the therapy. 11 patients were treated with Amphotericin B Lipid Complex (ABLC). Two of them had elevated Urea/Creatinine after initiating the therapy. Fluconazole was used in 14 patients.  2 of them had high Urea/Creatinine before therapy which did not show any further deterioration while on therapy. Two patients were treated with a combination of Fluconazoleand LAB. They both had high Urea/Creatinine before and after therapy. However, one of them was known to have renal failure. While 4 cases were treated with the combination of Fluconazole and ABLCamong whom one patient had high Urea/Creatinine before therapy that went down while on therapy.

Conclusions:

Although Amphotericin B is known to be associated with renal side effects, the newer preparations seem to offer a much safer alternative. Among the two available preparations, ABLCseemed to be safer in our experience. Fluconazole continued to have minimal renal side effects.  However, just like most of the published studies on this topic, our study was limited by the small number of patients included and the retrospective nature of the study.

Keywords: Invasive candida infections, Renal impairment, Amphotericin B Lipid Complex, Amphotericin B Liposomal Fluconazole.

Abbreviations:

ICI: Invasive Candida Infections, Amphotericin B Lipid Complex (ABLC), Amphotericin B Liposomal (ABL), CSF: cerebrospinal fluid, CLEAR: Collaborative Exchange of Antifungal Research,