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Response to “Is liposomal amphotericin B really safety in neonates?”
Early Human Development 89 (2013) 37
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Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev
Response to “Is liposomal amphotericin B really safety in neonates?” P. Manzoni ⁎, S. Rizzollo, D. Farina Neonatology and NICU, S. Anna Hospital, Torino, Italy
Sir, We thank Dr. Eda Karadag Oncel and colleagues for their comments on our paper “Liposomal amphotericin B does not induce nephrotoxicity or renal function impairment in premature neonates” that was recently published in EHD. Their report adds important evidence to the area of renal safety in preterm neonates treated with liposomal amphotericin B (LAMB). Despite the overall consideration that LAMB is generally well tolerated, they describe the occurrence of elevation of serum creatinine or hypokalemia in a slightly higher proportion of infants than in our series. However, their mean duration of treatment was 21 days vs. 14 in our series, and in addition they report some 37.5% of treated infant having a breakthrough bacterial infection during the antifungal
⁎ Corresponding author. E-mail address: [email protected] (P. Manzoni). 0378-3782/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2012.07.002
course. It is therefore possible that the proportion of critically ill patients in their series was higher than in ours, possibly due to different policies in instituting a pre-emptive antifungal treatment in our two different units. We feel to agree with their comment that critical patients with severe illness may be more prone to developing LAMB-related toxicity. As most of infants in need of antifungal treatment are critical by definition, we advocate for a prompter institution of pre-emptive antifungal treatment in the nursery – if needed – or to consider adoption of prophylaxis with fluconazole whenever indicated. These two strategies – along with a careful monitoring of the fluid imbalance – might ultimately allow that antifungal treatment with LAMB may not be necessarily performed in infants who are already way too critical to tolerate the drug.
Contents lists available at SciVerse ScienceDirect
Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev
Response to “Is liposomal amphotericin B really safety in neonates?” P. Manzoni ⁎, S. Rizzollo, D. Farina Neonatology and NICU, S. Anna Hospital, Torino, Italy
Sir, We thank Dr. Eda Karadag Oncel and colleagues for their comments on our paper “Liposomal amphotericin B does not induce nephrotoxicity or renal function impairment in premature neonates” that was recently published in EHD. Their report adds important evidence to the area of renal safety in preterm neonates treated with liposomal amphotericin B (LAMB). Despite the overall consideration that LAMB is generally well tolerated, they describe the occurrence of elevation of serum creatinine or hypokalemia in a slightly higher proportion of infants than in our series. However, their mean duration of treatment was 21 days vs. 14 in our series, and in addition they report some 37.5% of treated infant having a breakthrough bacterial infection during the antifungal
⁎ Corresponding author. E-mail address: [email protected] (P. Manzoni). 0378-3782/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2012.07.002
course. It is therefore possible that the proportion of critically ill patients in their series was higher than in ours, possibly due to different policies in instituting a pre-emptive antifungal treatment in our two different units. We feel to agree with their comment that critical patients with severe illness may be more prone to developing LAMB-related toxicity. As most of infants in need of antifungal treatment are critical by definition, we advocate for a prompter institution of pre-emptive antifungal treatment in the nursery – if needed – or to consider adoption of prophylaxis with fluconazole whenever indicated. These two strategies – along with a careful monitoring of the fluid imbalance – might ultimately allow that antifungal treatment with LAMB may not be necessarily performed in infants who are already way too critical to tolerate the drug.