FungizoneⓇ에서 AmBisomeⓇ으로의 약물 전환에 따른 환아의 신기능 변화

Abstract

Conventional amphotericin B (FungizoneⓇ) remains one of the most effective agents for the treatment of systemic fungal infections. Lipid formulations of conventional amphotericin B have been manufactured in attempts to reduce amphotericin B-related nephrotoxicity. Although many patients have been switched from FungizoneⓇ to a liposomal amphotericin B (AmBisomeⓇ) because of a decrease in renal function, its influence on renal function has not been evaluated. The objective of this study was to evaluate the changes in renal functions of pediatric patients who were switched from FungizoneⓇ to AmBisomeⓇ. Hospitalized patients(≤18 years old) whose antifungal therapy was switched were retrospectively analyzed from patient medical charts for the period from March 2004 to October 2005. The total 84 patients were started on FungizoneⓇ, and therapy was changed to AmBisomeⓇ in 17(20.2%) of the patients. Renal function was evaluated by examining changes in serum creatinine. The patient was considered to have stable renal function if the SCr change from the baseline value was <20%. Improvement in renal function was defined as a ≥20% decrease in SCr from the baseline value. Deterioration in renal function was defined as a ≥20% increase in SCr from the baseline value. 6 of the 17 patients (35.3%) had an improvement in renal function when switched to AmBisomeⓇ, with a mean±S.D. change in SCr of -35.1±14.3% (range, -20 ~ -62.5%), and 8 patients (47.1%) were stable in renal function. Limitations of this study are that data were collected for a small sample size (n=17) and are the many variables, other than amphotericin B-related renal dysfunction. Additional prospective studies with larger and controlled samples are needed to confirm these results.