It is considered appropriate to use Amphotericin B Lipid
Formulation when all the follow conditions are met:
1. Documented or suspected infection due to the following
organisms: Aspergillus sp., Candida sp., T. glabrata, B.
Dermatitidis, C. neoformans, H. Capsulatum, C. immitis, Mucorales, P.
brasiliensis, Sporothrix sp.
AND
The patient is not a candidate for other antifungal therapy
(e.g. azoles)
AND
The patient is refractory to standard amphotericin B
(treatment with ³
500mg)
OR
The patient is intolerant of amphotericin B due to serum
creatinine ³
2.5 mg/dL or doubling of baseline serum creatinine (note: patients with
chronic renal failure on dialysis are not candidates for ABLF).
2. The patient is not being treated for fever
of unknown origin (FUO) unless all current treatment modalities have failed
(including antibiotics, azoles and standard amphotericin B) and the
patient is refractory to or intolerant of standard amphotericin B (as defined
above)
Dosing:
FUO – 1mg/kg/day
Proven fungal infection: 3 mg/kg/day over 2 hours
Maximum Dose: 5 mg/kg/day as a single dose infusion
(1mg/mL) over 2 hours. (Doses given longer than 2 hours will need to be shaken
to disperse the suspension)
Monitor:
1. Culture/biopsy results and or temperature
2. Serum Creatinine, K, Mg, Na, WBC with diff
3. Toxicity
a. Nephrotoxicity ( further rise in SCr)
b. Hematocrit <22%
c. Infusion related adverse effects - (transient chills,
fever, rigors, thrombophlebitis)
Outcome:
