Intrathoracic Irrigation with AmBisome: No Established Dosing Guidelines
There are no published guidelines or established protocols for intrathoracic irrigation with AmBisome (liposomal amphotericin B), and this route of administration is not recommended based on available evidence.
Why This Route Lacks Support
The provided evidence extensively covers systemic intravenous dosing, intravitreal injection, intraventricular administration, and bladder irrigation, but no guideline or research addresses intrathoracic/intrapleural irrigation specifically 1.
Established Alternative Routes for Amphotericin B
If you are considering local amphotericin B delivery for a thoracic fungal infection, the following are the only documented non-systemic routes:
Documented Local Administration Routes:
- Intravitreal injection: 5-10 μg/0.1 mL sterile water for fungal endophthalmitis 1
- Intraventricular administration: 0.01-0.5 mg in 2 mL 5% dextrose in water through CNS devices 1
- Bladder irrigation: 50 mg/L sterile water daily for 5 days 1
None of these provide guidance for pleural or intrathoracic use.
Recommended Systemic Approach for Thoracic Fungal Infections
For pulmonary or thoracic fungal infections requiring amphotericin B, systemic intravenous therapy is the evidence-based approach:
For Severe Pulmonary Fungal Infections:
- Liposomal amphotericin B (AmBisome): 3-5 mg/kg/day IV for standard severe infections 2, 1
- For mucormycosis specifically: 5-10 mg/kg/day IV, with the full dose given from day one 3
- Amphotericin B lipid complex (ABLC): 5 mg/kg/day IV as an alternative 4
- Conventional amphotericin B deoxycholate: 0.7-1.0 mg/kg/day IV for life-threatening infections 2
Duration and Monitoring:
- Continue until clinical and radiological resolution of infection 3
- Combine with surgical debridement when feasible for optimal outcomes 3
- Monitor renal function, electrolytes, and liver function regularly 1, 4
Critical Safety Concerns
Attempting intrathoracic irrigation without established protocols poses significant risks:
- Unknown appropriate concentration for pleural tissue exposure
- Potential for severe local inflammatory reactions (amphotericin B is highly irritating to tissues)
- Unpredictable systemic absorption from pleural surfaces
- Risk of chemical pleuritis or pleural fibrosis
- No data on efficacy for this route
Clinical Bottom Line
If you are managing a thoracic fungal infection (empyema, pleural aspergillosis, etc.), use systemic IV liposomal amphotericin B at 3-5 mg/kg/day (or 5-10 mg/kg/day for mucormycosis) combined with surgical intervention when possible 2, 3. There is no safe, evidence-based dose for intrathoracic irrigation with AmBisome, and this route should be avoided in favor of proven systemic therapy.