A 35-year-old man with HIV infection and a CD4 count of 45 cells/μL presents with a 5-day history of fever, severe headache, photophobia, and neck stiffness. Cerebrospinal fluid analysis shows elevated opening pressure, low glucose, elevated protein, and positive India ink stain; culture confirms Cryptococcus neoformans. He is started on amphotericin B deoxycholate 0.7 mg/kg/day plus flucytosine. On hospital day 3, his serum creatinine increases from 1.0 to 3.2 mg/dL, urinalysis reveals muddy brown casts and proteinuria, and urine osmolality is elevated at 850 mOsm/kg. Physical examination shows blood pressure 96/60 mmHg and heart rate 112 bpm. Intravenous hydration with normal saline has been optimized. Which of the following interventions is most appropriate to reduce amphotericin B-induced nephrotoxicity while maintaining adequate antifungal coverage for CNS penetration?

1. A)Switch to liposomal amphotericin B at an equivalent doseGABARITO
2. B)Reduce amphotericin B dose by 50% and add itraconazole for synergy
3. C)Discontinue amphotericin B and initiate high-dose fluconazole monotherapy
4. D)Continue current regimen with addition of sodium bicarbonate to alkalinize urine
5. E)Maintain amphotericin B deoxycholate but increase saline infusion volume and frequency