Antimicrobials
Amphotericin - lipid associated

Amphotericin - lipid associated

Low
N/A
$500+/day

Spectrum of Activity

Dosing

General Information

Fungicidal therapy of yeast/fungus/mold infection (not for use in urinary tract infection)

Invasive candidiasis, aspergillosis, cryptococcosis

Visceral/mucocutaneous Leishmaniasis

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

Renal function, K, Mg, HCO3, liver enzymes, CBC. Frequency depends on course, but daily reasonable during initiation

Same toxicities as conventional Amphotericin B but with less frequency

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

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

Digoxin - increased digoxin toxicity with hypokalemia

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, see SCM orderset. Meperidine may be used for rigors.

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

Antimicrobial class: Antifungal - polyene - Lipid formulations (designed to minimize toxicity)

Average serum half life: 150.0

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor