Amphotericin B IV (see algorithm)
Test doses and incremental dosing are no longer recommended for the following reasons:
a. hypersensitivity reactions and anaphylaxis are rare
b. fever and chills associated with amphotericin B administration are not dose- or time-dependent
c. commercial formulation now in use is of high purity
d. causes unnecessary delays in patient receiving therapeutic dose.
The routine use of premedication (e.g. acetaminophen + diphenhydramine +/- corticosteroid +/- meperidine) is also no longer recommended prior to the initial dose of amphotericin B IV but may be administered promptly if an adverse reaction does occur, and then as pretreatment with subsequent amphotericin B doses.