Amphotericin B is an antifungal medication used to treat serious fungal infections. In pediatric patients, its use and dosage can vary depending on the specific formulation and the clinical context. Here are the primary formulations and their typical dosing guidelines for pediatric patients:

1. Conventional Amphotericin B

– Dosage:

– Neonates: 0.25–0.5 mg/kg/day initially, may be increased to 1 mg/kg/day.

– Older children: 0.5–1 mg/kg/day.

– Administration: Administered intravenously over 2-6 hours.

– Monitoring: Requires close monitoring for nephrotoxicity, electrolyte imbalances, and infusion-related reactions.

2. Lipid-Based Formulations

Lipid formulations of Amphotericin B are developed to reduce toxicity, especially nephrotoxicity, compared to the conventional form.

a. Liposomal Amphotericin B

– Dosage:

– 3–5 mg/kg/day for most infections.

– Administration: Administered intravenously over approximately 2 hours.

– Benefits: Lower incidence of nephrotoxicity compared to the conventional form.

b. Amphotericin B Lipid Complex

– Dosage: 5 mg/kg/day.

– Administration: Administered intravenously over 2 hours.

– Benefits: Reduced nephrotoxicity and infusion-related reactions compared to conventional Amphotericin B.

c. Amphotericin B Colloidal Dispersion

– Dosage: 3–4 mg/kg/day.

– Administration: Administered intravenously over 3-4 hours.

– Benefits: Lower nephrotoxicity compared to conventional Amphotericin B, but higher incidence of infusion-related reactions.

Clinical Considerations

– Pre-medication: To reduce infusion-related reactions (fever, chills, hypotension), pre-medication with acetaminophen, antihistamines, and corticosteroids may be necessary.

– Hydration: Adequate hydration is important to minimize renal toxicity. Saline loading (administering normal saline before and after Amphotericin B infusion) can be helpful.

– Monitoring: Regular monitoring of renal function, electrolytes (especially potassium and magnesium), liver function tests, and complete blood count (CBC) is crucial during treatment with Amphotericin B.