A 42-year-old woman with HIV infection (CD4 200 cells/μL) presents with fever, headache, and positive blood culture for Cryptococcus neoformans. Vital signs: BP 118/76, HR 102, RR 20, Temp 39.2°C, SpO2 98%. She is started on amphotericin B deoxycholate. On day 5, BUN rises from 18 to 72 mg/dL with creatinine 2.8 mg/dL; urinalysis shows no proteinuria. Which intervention would most reduce amphotericin B nephrotoxicity?
- A)Increase normal saline hydration before each infusion
- B)Add concurrent pentamidine for synergistic fungicidal activity
- C)Administer acetaminophen before each infusion
- D)Reduce the amphotericin B dose by half
- E)Switch to liposomal amphotericin B formulationGABARITO
Explicação
Liposomal amphotericin B has significantly lower nephrotoxicity than amphotericin B deoxycholate because the lipid formulation reduces renal drug accumulation while maintaining fungicidal efficacy, making it the preferred agent in renal impairment. Ver explicação completa e trilha adaptativa →