Management by Inj Liposomal amphotericin B (LAmB):
Test dose
•Inj. Liposomal Amphotericin- B 1 vial (50 mg) to be diluted in 12 ml of the diluent and 0.25ml (1 mg) of a solution made, to be mixed in 100ml Dextrose and to be infused in 30 minutes.
•Observe for fever and reactions
Pre-hydration
•500 mL NS over 30 minutes
•To reduce the risk of renal toxicity and hypokalaemia:- 500ml Normal Saline + 1 Amp (20mmol) KCL
Therapeutic dose
•5mg-10 mg /kg/day Amphotericin B in 500 mL D5 with 10 Units HIR over 3 hrs (To be covered in black sheet)
PostHydration
•500 mL NS over 30 minutes
Postdose
•KFT with Serum electrolytes after Every dose of Amphotericin B
•Fill Amphotericin monitoring chart
Duration: Continue for 14 to 21 days depending on severity/till clinical resolution and radiological stabilization; after 14days of therapy, shift to oral Posaconazole (200mg four times a day) if clinically stable.
Source: AIIMS