Spectrum: Local Antimicrobial Stewardship, for IWK Health Centre

Amphotericin B deoxycholate /conventional

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$75/day

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

General Pediatric

Usual: 0.25-1 mg/kg/dose IV q24h
Dosing may go up to 1.5 mg/kg/dose

Neonatal

Usual: 0.5-1 mg/kg/dose IV q24h
Dosing may go up to 1.5 mg/kg/dose

Renal

Contact pharmacy for more information regarding use in renal impairment.

General Information

Common Usage

Common Usage

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

Drug Monitoring

Drug Monitoring

  • Renal function

  • Fluid status

  • Serum electrolytes (K, Mg)

  • Liver enzymes

  • CBC with differential.

Adverse Effects

Adverse Effects

  • Infusion related symptoms: fever/rigors/nausea/vomiting/headache

  • Electrolyte abnormalities - hypoKalemia and hypoMagnesemia, loss of bicarbonate

  • Nephrotoxicity ++

  • Anemia

  • Phlebitis

Major Interactions

Major Interactions

Enhance nephrotoxic effect with concomitant use of other nephrotoxins - use should be minimized during amphotericin therapy.

Additional Information

Additional Information

Amphotericin B deoxycholate (conventional) is the preparation of choice in neonates.

Premedicate with acetaminophen, diphenhydramine, or hydrocortisone for infusion related symptoms.

Pharmacology

Pharmacology

Antimicrobial class: Antifungal - polyene

Average serum half life:

  • Premature neonates (GA: 27.4 ± 5 weeks): 14.8 hours (range: 5 to 82 hours)

  • Infants and Children (4 months to 14 years): 18.1 ± 6.6 hours (range: 11.9 to 40.3 hours)

Route of Elimination: Urine (2% to 5% unchanged); ~40% eliminated over 7-day period and may be detected in urine for up to 8 weeks after discontinued use