What are the doses of Amphotericin B (antifungal medication)?

From the Guidelines

The recommended dose of amphotericin B for invasive candidal infections is 0.5-1.5 mg/kg/day intravenously, with a typical dose of 0.5-0.7 mg/kg daily for conventional amphotericin B deoxycholate, and 3-5 mg/kg daily for lipid formulations 1.

Key Considerations

• The dose of amphotericin B may vary depending on the formulation and indication, as well as the severity of the infection and the patient's renal function.
• Lipid formulations of amphotericin B, such as AmBisome and Abelcet, are generally less nephrotoxic than conventional amphotericin B deoxycholate, but are more expensive.
• Treatment duration depends on the infection being treated, typically ranging from 1-2 weeks for less severe fungal infections to 4-12 weeks for invasive fungal diseases.
• Patients should receive premedication with acetaminophen and diphenhydramine to reduce infusion reactions, and careful monitoring of renal function, electrolytes, and complete blood counts is essential during treatment.

Formulation-Specific Dosing

• Conventional amphotericin B deoxycholate: 0.5-1.5 mg/kg/day intravenously
• Liposomal amphotericin B (AmBisome): 3-5 mg/kg/day intravenously
• Amphotericin B lipid complex (Abelcet): 5 mg/kg/day intravenously

Important Safety Considerations

• Nephrotoxicity is the most common serious adverse effect associated with amphotericin B therapy, resulting in acute renal failure in up to 50% of recipients 1.
• Infusion-related reactions, such as fever, chills, and nausea, can occur, but are less frequent in children than adults.
• Careful monitoring of renal function, electrolytes, and complete blood counts is essential during treatment to minimize the risk of adverse effects.

From the FDA Drug Label

CAUTION: Under no circumstances should a total daily dose of 1. 5 mg/kg be exceeded. In patients with good cardio-renal function and a well tolerated test dose, therapy is usually initiated with a daily dose of 0. 25 mg/kg of body weight. However, in those patients having severe and rapidly progressive fungal infection, therapy may be initiated with a daily dose of 0.3 mg/kg of body weight. In patients with impaired cardio-renal function or a severe reaction to the test dose, therapy should be initiated with smaller daily doses (i.e., 5 to 10 mg). Depending on the patient's cardio-renal status, doses may gradually be increased by 5 to 10 mg per day to final daily dosage of 0.5 to 0. 7 mg/kg. Total daily dosage may range up to 1.0 mg/kg per day or up to 1. 5 mg/kg when given on alternate days.

The recommended doses of amphotericin B are:

• 0.25 mg/kg per day for patients with good cardio-renal function
• 0.3 mg/kg per day for patients with severe and rapidly progressive fungal infection
• 5 to 10 mg per day for patients with impaired cardio-renal function or severe reaction to the test dose
• Up to 1.0 mg/kg per day or 1.5 mg/kg when given on alternate days 2 2 Key points to consider when administering amphotericin B:
• Do not exceed a total daily dose of 1.5 mg/kg
• Individualize the dosage based on the patient's clinical status
• Monitor the patient's temperature, pulse, respiration, and blood pressure during administration 2

From the Research

Amphotericin B Doses

• The recommended dose of Amphotericin B colloidal dispersion (ABCD) is 3-4 mg/kg/day 3
• The recommended dose regimen for Amphotericin B lipid complex (ABLC) is 5 mg/kg/day 3, 4
• The optimal dosing for liposomal Amphotericin B (L-AmB) remains unclear but is generally between 3 and 5 mg/kg/day 3 and 3-6 mg/kg/day 4
• For the treatment of cryptococcal meningitis, a single high dose of liposomal amphotericin B (10 mg per kilogram of body weight) on day 1 plus 14 days of flucytosine and fluconazole has been shown to be noninferior to the current World Health Organization-recommended treatment 5
• The dose of amphotericin B for daily use can be 30 to 50 mg for deoxycholate (D-Amph) or 50 mg for liposomal amphotericin B (L-AmB), with a significant increase in minimum concentration (Cmin) with L-AmB 100 mg/day 6

Formulations and Efficacy

• Liposomal amphotericin B (L-AmB) has similar or superior efficacy relative to amphotericin B in various fungal infections and also in the empirical treatment of febrile neutropenia 3
• The new lipid formulations of amphotericin B are effective in various invasive fungal infections and exhibit reduced nephrotoxicity compared with conventional amphotericin B 3, 4
• Amphotericin B and fluconazole is a potent combination therapy for cryptococcal meningitis, with the greatest antifungal effects achievable with these drugs alone or in combination 7