Therapeutic drug monitoring of liposomal amphotericin B in children. Are we there yet? A systematic review.
J Antimicrob Chemother
; 79(4): 703-711, 2024 Apr 02.
Article
in En
| MEDLINE
| ID: mdl-38252921
ABSTRACT
INTRODUCTION:
Therapeutic drug monitoring (TDM) is a tool that supports personalized dosing, but its role for liposomal amphotericin B (L-amb) is unclear. This systematic review assessed the evidence for L-amb TDM in children.OBJECTIVES:
To evaluate the concentration-efficacy relationship, concentration-toxicity relationship and pharmacokinetic/pharmacodynamic (PK/PD) variability of L-amb in children.METHODS:
We systematically reviewed PubMed and Embase databases following PRISMA guidelines. Eligible studies included L-amb PK/PD studies in children aged 0-18â years. Review articles, case series ofRESULTS:
In total, 4220 studies were screened; 6 were included, presenting data on 195 children. Invasive candidiasis and aspergillosis were the two most common infections treated with L-amb. Studies showed significant PK variability due to age (mean age ranged from 14â days to 17â years), body weight, non-linear PK and changes in the volume of distribution. Limited evidence supported a peak concentration/MIC (Cmax/MIC) of 25-50 for optimal efficacy and an AUC24 of >600â mg·h/L for nephrotoxicity. L-amb doses of 2.5-10â mg/kg/day were reported to achieve Cmax/MICâ>â25 using an MIC of 1â mg/L.CONCLUSIONS:
While significant PK variability was observed in children, evidence to support routine L-amb TDM was limited. Further studies on efficacy and toxicity benefits are required before routine TDM of L-amb can be recommended.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Guideline
/
Systematic_reviews
Language:
En
Journal:
J Antimicrob Chemother
Year:
2024
Document type:
Article
Affiliation country:
Australia