It is considered appropriate to use Amphotericin B in the following conditions.

1. Culture positive mycosis due to the following organisms -Candida sp., Tglabrata, Aspergillus sp., B. Dermatitidis, C. neoformans, H. Capsulatum, C. immitis, Mucorales, P. brasiliensis, Sporothrix sp.

2. Empiric therapy for febrile neutropenic patients after 5-7 days unresponsive to combination antibiotic therapy.

Dose:

0.25 to 1.5 mg/kg/day

Monitor:

a. Culture/biopsy performed

b. Serum Cr., K, Mg, Na, WBC with diff

c. Sodium Loading with approximately 150 mEq. sodium before dose except in ascites, renal failure or congestive heart failure.

d. Pretreatment for adverse infusion reactions with acetaminophen, diphenhydramine, hydrocortisone and/or meperidine.

e. Toxicity

    1.     Nephrotoxicity ( Cr > 3.0 or doubling of Cr.)

    2.     Hematocrit < 22%

    3.     Infusion related adverse effects - (fever, chills, rigors, thrombophlebitis)

Outcome:

Clinical improvement within 6 - 12 weeks