Liposomal Amphotericin B Treatment for Severe Fungal Infections
Dosing Recommendations by Infection Type
- For severe fungal infections, liposomal amphotericin B is recommended at a dose of 5 mg/kg/day for patients without CNS involvement and 10 mg/kg/day for those with CNS involvement, administered intravenously for 4-6 weeks during induction and consolidation phases 1, 2, 3
- Liposomal amphotericin B (3-5 mg/kg/day IV) should be considered if there is persistent candidemia or clinical unresponsiveness to echinocandins without evidence of resistance to amphotericin B 1, 3
- For neonates with disseminated candidiasis, conventional amphotericin B at 1 mg/kg/day is recommended 5
- Primary therapy: Liposomal amphotericin B 5 mg/kg/day IV (without CNS involvement) or 10 mg/kg/day IV (with CNS involvement) 2, 3
- Duration: 4-6 weeks for induction and consolidation treatment 1, 2
- Both antifungal therapy and immediate surgical debridement are recommended for COVID-19 associated mucormycosis 2
- Maintenance therapy should continue for 3-6 months until resolution of clinical signs and symptoms 3
Administration Guidelines
- Pre-medication with diphenhydramine or acetaminophen prior to infusion is recommended to avoid infusion-related reactions 1, 4
- To avoid nephrotoxicity, 1 L of normal saline can be given before and after infusion in patients who can tolerate fluids 2, 4
Alternative Formulations and Therapies
- If liposomal amphotericin B is unavailable, alternatives include amphotericin B deoxycholate (1-1.5 mg/kg/day) administered in 5% dextrose with slow infusion over 6-8 hours 1, 3
- For maintenance therapy after initial response: posaconazole or isavuconazole 1, 3