Treatment of candiduria with liposomal amphotericin B (L-AmpB-LRC) in children

Urinary tract candidiasis usually follows haematogenous spread or ascending infection in patients on immunosuppressants, broad spectrum antibacterial agents or with indwelling catheters. Isolation of candida species in urine drawn by suprapubic puncture of the urinary bladder or a clean midstream sample is diagnostic of candiduria (Anonymous, 1988). As with other forms of candidiasis, treatment of the precipitating factor is of primary importance. Continued presence of large numbers of organism in the urine and persistence of symptoms when no bacterial pathogen is found, are indications for use of systemic antifungal agents. Amphotericin B is one of the drugs used in the treatment of urinary tract candidiasis. However, the many acute and chronic side effects (in particular nephrotoxicity) associated with intravenous administration of amphotericin B often make such usage difficult. Amphotericin B encapsulated in liposomes prepared from a variety of lipids has been reported to be safer and more effective than conventionally administered amphotericin B in animals and in patients. We have prepared liposomal amphotericin B (L-AmpB-LRC) using soya phosphatidylcholine and cholesterol in a 7:3 molar ratio and have carried out phase I and pharmacokinetic studies. It has been shown to be safe and effective. In particular, it was found to be safe in adult patients with renal disease (unpublished data) and effective in a patient with chronic disseminated candidiasis resistant to conventional amphotericin B. We report here the successful treatment of candiduria in three children with nephrotic syndrome using our liposomal amphotericin B.