Amphotericin B Overdose in Pediatric Patients with Associated Cardiac Arrest

Abstract

OBJECTIVE:

To report the first five cases of amphotericin B overdose with secondary cardiac complications in a pediatric population. Treatment is also presented.

SETTING:

Hospital.

PATIENTS:

Two infants and three children inpatients receiving amphotericin B.

INTERVENTIONS AND RESULTS:

Cardiac complications were observed in five pediatric patients who received between 4.6 and 40.8 mg/kg/d of amphotericin B. Cardiac arrest occurred in all patients, and four patients died. A detailed description of the cardiac event is provided for one patient who was on a cardiac monitor during the adverse reaction. Hydrocortisone prophylaxis and verapamil therapy were the primary therapies used in patient 1 (the only survivor). Evaluation of the literature provides substantial evidence for the use of hydrocortisone in prevention of cardiac arrhythmias.

CONCLUSIONS:

Amphotericin B overdose can be fatal in children and infants. The presentation in humans appears similar to that in dogs where cardiac arrhythmias occurred at doses of 5–15 mg/kg. Hydrocortisone may decrease the incidence of mortality associated with cardiac arrhythmias in children receiving amphotericin B overdoses. Animal studies are necessary to evaluate this observation and potential disadvantages of hydrocortisone usage.