Spectrum: Local Antimicrobial Stewardship, for Bakersfield Memorial Hospital

Amphotericin - Lipid Associated

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

Dose adjustment is unnecessary for pre-existing renal dysfunction however, decreased renal function caused by amphotericin may warrent a dose adjustment (e.g. a 50% reduction of the total daily dose or dosing every 48 hr)

Adult
  • For patients who experience nonanaphylactic infusion-related reactions, premedicate 30 to 60 mintures before with an NSAID and/or diphenhydramine, acetaminophen with diphenhydramine, or hydrocortisone.

Ambisome
3-6mg/kg IV every 24 hr infused over several hours

General Information

Common Usage

Common Usage

Fungicidal therapy of yeast/fungus/mold infection.

Invasive candidiasis, aspergillosis, cryptococcosis.

Visceral/mucocutaneous Leishmaniasis.

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

Not for use in urinary tract infection.

Drug Monitoring

Drug Monitoring

Laboratory

  • At least twice weekly - SCr, K, Mg

  • Weekly - Liver enzymes, CBC

Clinical
Infusion related reactions

Adverse Effects

Adverse Effects

Same toxicities as conventional Amphotericin B but with less frequency.

  •  Nephrotoxicity ++

  •  Anemia

  •  Phlebitis

  •  Arachnoiditis

  •  Urinary retention

  •  Paresthesias

Infusion related symptoms

  •  Fever

  •  Rigors

  •  N/V

  •  Headache

Electrolyte abnormalities

  •  HypoK and HypoMg

  •  Loss of bicarb

  •  See additional information

Major Interactions

Major Interactions

Main concern is concomitant nephrotoxins. Use should be minimized during amphotericin therapy.

Increased digoxin toxicity with hypokalemia.

Additional Information

Additional Information

Lipid associated AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure.

Premedication with acetaminophen, diphenhydramine, or hydrocortisone are used.

Meperidine may be used for rigors.

Pay careful attention to electrolyte and fluid status with boluses (usually 500mL) before and after infusion, as well as K and Mg supplementation PRN.

Pharmacology

Pharmacology

Antimicrobial class: Antifungal. Polyene. Lipid formulations designed to minimize toxicity.

Average serum half life: 150 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor