Evidence map›Paper›PMID 38252921›Full record

SynthesisThe Journal of antimicrobial chemotherapy2024

Therapeutic drug monitoring of liposomal amphotericin B in children. Are we there yet? A systematic review.

Tony Lai, Chin-Yen Yeo, Bradley Rockliff, Michael Stokes, Hannah Yejin Kim, Ben J Marais, Andrew J McLachlan, Jan-Willem C Alffenaar

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Journal of antimicrobial chemotherapy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
1.6field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Tony LaiPharmacy Department, The Children's Hospital at Westmead, Sydney, NSW, Australia.ORCID 0000-0001-9761-0072
Chin-Yen YeoPharmacy Department, Concord Hospital, Sydney, Australia.
Bradley RockliffPharmacy Department, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Michael StokesPharmacy Department, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Hannah Yejin KimSydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID 0000-0002-1808-5036
Ben J MaraisThe University of Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Australia.
Andrew J McLachlanSydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID 0000-0003-4674-0242
Jan-Willem C AlffenaarThe University of Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW, Australia.ORCID 0000-0001-6703-0288
The University of Sydney · AUChildren's Hospital at Westmead · AUConcord Repatriation General Hospital · AU

Funding

Australian Government (RTP) Scholarship
6 · The paper itself

Abstract

introductionTherapeutic 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.

objectivesTo evaluate the concentration-efficacy relationship, concentration-toxicity relationship and pharmacokinetic/pharmacodynamic (PK/PD) variability of L-amb in children.

methodsWe systematically reviewed PubMed and Embase databases following PRISMA guidelines. Eligible studies included L-amb PK/PD studies in children aged 0-18 years. Review articles, case series of <five patients, editorials and animal studies were excluded. Quality assessment was performed using the Critical Appraisal of Clinical Pharmacokinetics tool. The concentration-efficacy and concentration-toxicity relationships and PK/PD variability were analysed.

resultsIn 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 14 days to 17 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 >600 mg·h/L for nephrotoxicity. L-amb doses of 2.5-10 mg/kg/day were reported to achieve Cmax/MIC > 25 using an MIC of 1 mg/L.

conclusionsWhile 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.

Indexed as

Amphotericin BAntifungal AgentsDrug MonitoringAdolescentAspergillosisChildChild, PreschoolHumansInfantInfant, NewbornMicrobial Sensitivity TestsAmphotericin BAntifungal Agentsliposomal amphotericin B

Identifiers

PMID38252921
PMCPMC10984953
OpenAlexW4391095179

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.