Amphotericin B Dosage and Administration Guidelines

Introduction to Amphotericin B Therapy

The Centers for Disease Control and Prevention recommends a dosage of 0.5-1.5 mg/kg administered once daily intravenously over 1-2 hours, with a concentration of 0.1 mg/mL for serious fungal infections 1

The recommended final daily dosage of conventional amphotericin B typically ranges from 0.5-0.7 mg/kg 1
For life-threatening infections or those caused by less susceptible species, dosages up to 1 mg/kg daily should be considered 2
Hydration with 0.9% saline intravenously 30 minutes before infusion can ameliorate nephrotoxicity 1

The Infectious Diseases Society of America recommends Amphotericin B lipid complex (ABLC) at 5 mg/kg daily IV 3, 4, 5
Liposomal amphotericin B (L-AmB) is recommended at 3-5 mg/kg daily IV 3, 4, 5
Amphotericin B colloidal dispersion (ABCD) is recommended at 3-6 mg/kg daily IV 3, 5
Lipid formulations have similar efficacy but less nephrotoxicity compared to conventional amphotericin B 3
Liposomal amphotericin B appears to provide the greatest renal protection among lipid formulations 2

For pediatric patients with invasive candidiasis, the recommended dosage is 0.5-1.5 mg/kg daily IV of conventional amphotericin B 1, 4
For neonates, the recommended dosage is similar to adults, 0.6-1.0 mg/kg daily IV 4, 5
For immunocompromised patients with severe fungal infections, lipid formulations at 3-5 mg/kg daily are preferred 8, 6

For candidemia, treatment should continue for 14 days after last positive blood culture and resolution of signs and symptoms 1, 4
For disseminated candidiasis, treatment may last 3-6 months and until resolution or calcification of radiologic lesions 4
For cryptococcal meningitis, at least 2 weeks of amphotericin B followed by fluconazole is recommended 6

Renal function, electrolytes, and liver function tests should be monitored regularly 1
Infusion-related reactions can be ameliorated by premedication with diphenhydramine 6
For patients with persistent candidemia despite appropriate therapy, investigation for deep tissue focus of infection is recommended 1