Amphotericin B Therapy

Indications and Usage

The Centers for Disease Control and Prevention recommends amphotericin B for treatment of progressive and potentially life-threatening fungal infections, with conventional amphotericin B administered at 0.5-1.5 mg/kg daily intravenously or lipid formulations at 3-5 mg/kg daily depending on the specific infection and patient factors 1
The Infectious Diseases Society of America indicates that primary indications for amphotericin B include invasive candidiasis and candidemia 1, 2, 3
The Infectious Diseases Society of America recommends amphotericin B for sporotrichosis, with at least 12 months of therapy 4
The Centers for Disease Control and Prevention suggests that amphotericin B is indicated for empiric therapy in febrile neutropenic patients 5

The Centers for Disease Control and Prevention recommends a standard dosage of 0.5-1.5 mg/kg administered once daily intravenously over 1-2 hours for conventional amphotericin B 1
The Infectious Diseases Society of America indicates that for severe or life-threatening infections, 0.7-1.0 mg/kg daily of conventional amphotericin B is recommended 4, 5
The Infectious Diseases Society of America suggests that for neonates with disseminated candidiasis, 1 mg/kg daily of conventional amphotericin B is recommended 5

The Centers for Disease Control and Prevention recommends continuing treatment for 14 days after the last positive blood culture and resolution of signs and symptoms for candidemia 1
The Infectious Diseases Society of America indicates that for disseminated candidiasis, treatment should continue until all signs and symptoms of infection have resolved 1
The Infectious Diseases Society of America recommends at least 2 weeks of amphotericin B therapy for cryptococcal meningitis, followed by fluconazole 6

The Centers for Disease Control and Prevention notes that primary toxicity of amphotericin B is nephrotoxicity, defined by substantial azotemia from glomerular damage 1
The Centers for Disease Control and Prevention indicates that nephrotoxicity can be ameliorated by hydration with 0.9% saline IV 30 minutes before infusion 1, 6
The Centers for Disease Control and Prevention suggests that infusion-related reactions, such as fever, chills, nausea, and vomiting, can be alleviated by pretreatment with acetaminophen or diphenhydramine 1, 6

The Centers for Disease Control and Prevention recommends 0.5-1.5 mg/kg daily IV or 50 mg/m²/day of amphotericin B for children 1
The Infectious Diseases Society of America indicates that for neonates with disseminated candidiasis, 1 mg/kg daily IV of amphotericin B is recommended 5
The Infectious Diseases Society of America suggests that amphotericin B is the preferred antifungal for severe fungal infections during pregnancy, with lipid formulations at 3-5 mg/kg daily recommended 4

The Infectious Diseases Society of America recommends monitoring renal function, electrolytes, and liver function tests regularly 6
The Centers for Disease Control and Prevention suggests that for patients with persistent candidemia despite appropriate therapy, investigation for deep tissue focus of infection is necessary 1

For severe or life-threatening fungal infections with potential renal impairment, the Infectious Diseases Society of America recommends dosing conventional amphotericin B deoxycholate at 0.7-1.0 mg/kg/day intravenously, with the understanding that lipid formulations are strongly preferred when available due to significantly reduced nephrotoxicity 7, 8
The Centers for Disease Control and Prevention recommends 0.7 mg/kg/day combined with flucytosine 100 mg/kg/day for at least 2 weeks for cryptococcal meningitis in HIV patients 8

For diffuse pulmonary histoplasmosis, the Infectious Diseases Society of America recommends 0.7 mg/kg/day initially, particularly for patients requiring ventilatory support 9
For neonates with disseminated candidiasis, the American Academy of Pediatrics recommends 1 mg/kg/day 10

The European Society of Clinical Microbiology and Infectious Diseases recommends avoiding conventional amphotericin B in patients with pre-existing renal dysfunction when lipid formulations are available 11, 7, 12
If lipid formulations are available, the Infectious Diseases Society of America recommends using liposomal amphotericin B (3-5 mg/kg/day) or amphotericin B lipid complex (5 mg/kg/day) instead 11, 7, 12

The Centers for Disease Control and Prevention recommends monitoring serum creatinine, electrolytes (especially potassium and magnesium), and renal function frequently 8

The Infectious Diseases Society of America discourages the use of conventional amphotericin B deoxycholate whenever lipid formulations are available, especially for mucormycosis, where liposomal amphotericin B 5-10 mg/kg/day is strongly recommended 11
For pre-existing renal impairment, the Centers for Disease Control and Prevention recommends using lipid formulations (3-6 mg/kg/day) instead of conventional amphotericin B 8, 12