What is the maximum recommended daily dose of conventional amphotericin B for injection in neonates?

• A. 0.5 mg/kg/day
• B. 3.0 mg/kg/day
• C. 5.0 mg/kg/day
• D. 1.5 mg/kg/day

Answer: (D)

Neonates are especially sensitive to the kidney toxicity of conventional amphotericin B, so its daily dose is kept low to balance antifungal effect with safety. The maximum recommended daily dose for the conventional formulation in this population is 1.5 mg/kg. Doses at or above this level have a higher risk of nephrotoxicity, electrolyte losses (like potassium and magnesium), and other renal complications, which neonates tolerate poorly due to immature kidney function. If a higher dose is needed for adequate fungal control, clinicians typically switch to liposomal amphotericin B, which allows higher dosing with less renal toxicity. In practice, dosing is started low and titrated with careful monitoring of renal function and electrolytes, aiming to stay at or below 1.5 mg/kg/day for the conventional form.