Figure 1112

Proposed approach for management of amphotericin B (AmB) therapy. Several new formulations of amphotericin have been developed either by incorporating ampho-tericin into liposomes or by forming complexes to phospholipid. In early studies, nephrotoxicity was reduced, allowing an increase of the cumulative dose. Few studies have established a therapeutic index between antifungal and nephrotoxic effects of amphotericin. To date, the only clinically proven intervention that reduces the incidence and severity of nephrotoxicity is salt supplementation, which should probably be given prophylactically to all patients who can tolerate it. (From Bernardo JF, et al. [16]; with permission.)

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