Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Amphotericin B Deoxycholate

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Renal

Adult

  • Requires ID consult

  • 0.7-1.5mg/kg IV q24h

  • Premedication required (consider acetaminophen, diphenhydramine and a steroid)

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

  •  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

Liposomal formulations preferred in almost all scenarios for systemic treatment (except NICU).

Premedication with acetaminophen, diphenhydramine or hydrocortisone is used. Meperidine may be used for rigors.

Pay 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 hours

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic