Spectrum: Local Antimicrobial Stewardship, for Providence Health Care

Amphotericin B deoxycholate

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

Adult

0.3-1.5mg/kg IV daily, infused over several hours.

Must be approved by Infectious Disease.

General Information

Common Usage

Common Usage

Fungicidal therapy of yeast/fungus/mold infection, especially of the urinary tract as lipid formulations are otherwise preferred to minimize toxicity

Induction therapy for dimorphic fungii (cocci, blasto, histo)

Drug Monitoring

Drug Monitoring

Renal function, K, Mg, HCO3, liver enzymes, CBC.

Frequency depends on course, but daily reasonable during initiation

Adverse Effects

Adverse Effects

Infusion related symptoms: fever/rigors/N/V/headache (see additional information)

Electrolyte abnormalities - hypoK and hypoMg, loss of bicarb (see additional information re: electrolyte infusions)

Nephrotoxicity ++

Anemia
Phlebitis
Arachnoiditis
Urinary retention
Paresthesias

Major Interactions

Major Interactions

Main concern is concomitant nephrotoxins - use should be minimized during amphotericin therapy

Digoxin - increased digoxin toxicity with hypokalemia

Additional Information

Additional Information

Infectious Disease to approve use.

Careful attention to electrolyte and fluid status with boluses (usually 500mL) of NS before and after infusion, as well as K and Mg supplementation PRN

Pharmacology

Pharmacology

Antimicrobial class: Antifungal - polyene

Pregnancy category: B

Average serum half life: 24.0

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic