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Practical guidelines for preparing and administering amphotericin B.

P E Kintzel1, G H Smith

  • 1Cancer Biology Graduate Program, College of Medicine, University of Arizona (UA), Tucson 85724.

American Journal of Hospital Pharmacy
|May 1, 1992
PubMed
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Updated guidelines for amphotericin B preparation and administration are presented. Proper storage, administration rates, and dosing are crucial for effective treatment of fungal infections with this essential antifungal medication.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Amphotericin B is a critical antifungal agent requiring precise preparation and administration.
  • Current practices for amphotericin B handling vary, necessitating updated, evidence-based guidelines.
  • Understanding stability and compatibility is vital for safe and effective intravenous therapy.

Framework:

  • Evaluation of current amphotericin B preparation and administration protocols.
  • Presentation of updated guidelines for storage, administration, and dosing.
  • Assessment of compatibility with various intravenous containers and solutions.

Implementation:

  • Intravenous admixtures of amphotericin B have specific expiration dates (35 days for 0.25 mg/mL, 36 hours for 1.4 mg/mL).

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  • Storage at 4-8°C is recommended due to the lack of a bacteriostatic agent in commercial formulations.
  • Admixtures are compatible with polyolefin, glass, and polyvinyl chloride containers; avoid evacuated containers with buffers.
  • Buffering agents are unnecessary if the 5% dextrose injection pH exceeds 4.2.
  • Recommended intravenous dose is 0.5-1 mg/kg/day, with a 1-mg test dose advised.
  • Infusion over 1-2 hours (≤50 mg/hr) is suitable for patients with adequate renal function.
  • Bladder instillation (50 mg/L) is an option for fungal cystitis.

    • Implications:

    • Adherence to updated guidelines ensures optimal stability and efficacy of amphotericin B therapy.
    • Standardized protocols minimize risks of precipitation and adverse events.
    • Appropriate dosing and administration prevent delays in therapeutic effect and manage infusion-related reactions.
    • Cautious sodium supplementation is advised based on individual patient needs.