Amphotericin B is our first-line anti-fungal agent. Amphotericin B Lipid Complex (Abelcet) may be substituted for amphotericin B if the baby is unable to tolerate amphotericin B or has renal insufficiency. Because of its caustic nature, amphotericin B must be carefully ordered and administered.

Dosing

Amphotericin B may be initiated at 1 mg/kg/dose q 24 hours

 

Ablecet may be initiated at 5 mg/kg/dose q 24 hours

 

Central access (PICC, BROVIAC® catheter* or UVC) is the preferred route of administration. A peripheral iv can be used if it is the only available access. However, if a peripheral iv is used, the infusion site should be carefully checked every 30 minutes for potential extravasation.

Amphotericin B or Ablecet should be administered over 4 hours.

Amphotericin B is incompatible with most medications and electrolytes and can only be administered in a dextrose solution.

During amphotericin administration, typically the only fluid the patient can receive is the medication. The volume and amount of glucose in which the amphotericin is suspended can be manipulated to maintain a constant glucose infusion rate. Ideally, order the amphotericin in the same glucose concentration as the patient’s TPN and in 4 hours worth of volume and run at the same rate as the replaced TPN. However, the minimum volume to dilute amphotericin is 10mL : 1 mg; so for example, given a 1 mg/kg dose, the least volume that can be administered is 10 mL/kg over the four hours.

Be aware that the patient’s daily electrolyte allowance must be delivered in only 20 hours worth of TPN or IVF since 4 hours is dedicated to electrolyte-free fluid administration.

To administer amphotericin, the nurse should hold other IV fluids and flush the line through which amphotericin will be given with D5W before infusion. A 50ml bag of D5W for flush is provided by pharmacy with the medication. The line should also be flushed with D5W after amphotericin administration before iv fluids/TPN are reinitiated.

References:

Young TE, Mangrum OB. Neofax 2001: A Manual of Drugs Used in Neonatal Care, 14^th ed. Acorn Publishing. pgs. 6 & 9.

Baley JE, et al. Pharmacokinetics, outcome of treatment, and toxic effects of amphotericin B and 5-fluorocytosine in neonates. J Pediatrics 1990; 116: 791-7.

Kingo AR, Smyth JA, Waisman D. Lack of evidence of amphotericin B toxicity in very low birth weight infants treated for systemic candidiasis. Ped Infect Dis J 1997; 16: 1002-3.

Adler-Shohet F, Waskin H, Lieberman JM. Amphotericin B lipid complex for neonatal invasive candidiasis. Arch Dis Child Fetal & Neonatal Ed 2001; 84: F131-3.

Presented at Clinical Case Review Conference 1/15/02 and approved at Clinical Division Meeting 1/21/02.

* BROVIAC® is a registered trademark of C.R.Bard, Inc. and its related company, BCR, Inc.