- Amphotericin B, IV, 0.7–1 mg/kg daily, dose and duration of therapy depend on indication for use and infecting organism.
- Reconstitue in 5% dextrose water only (as incompatibile with saline solution).
- Administer over a period of 2–6 hours.
- Ensure adequate hydration to minimise the risk of nephrotoxicity.
Monitoring
- Serum potassium, magnesium and creatinine (baseline and twice weekly). Monitoring of serum potassium and creatinine should occur more frequently in neutropenic patients (3 times a week).
- Monitor haemoglobin (baseline and weekly).
- Careful attention to fluid monitoring of intake and output.
- For management of hypokalaemia, see section 7.2.2: Hypokalaemia.
Management of elevated creatinine
If creatinine increases by ≥2 fold from baseline value, either omit an amphotericin B dose, or increase pre-hydration to 1 litre 8 hourly.
- Once improved, restart at 0.7 mg/kg daily and consider alternate day amphotericin B.
- If creatinine remains elevated i.e. ≥2 fold from baseline value, discontinue amphotericin B and continue with fluconazole, oral, 800 mg daily (for fungal infections known to be responsive to fluconazole, e.g. Cryptococcus).
(Adapted from: WHO. Rapid advice: diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: Prevention, monitoring and management of amphotericin B toxicity. 2011 [Online] [Accessed March 2016] http://www.ncbi.nlm.nih.gov/books/NBK299520/pdf/Bookshelf_NBK299520.pdf