Antimicrobials
Amphotericin B - conventional

Amphotericin B - conventional

Low
N/A

Dosing

General Information

Infectious Diseases consultation recommended.

  • Renal
  • CBC
  • K
  • HCO3
  • Mg
  • Liver profile

Frequency depends on course, but daily reasonable during initiation.

Careful attention to electrolyte and fluid status with boluses (usually 500ml) of NS before and after infusion.

  • Infusion related symptoms are common: fever/rigors/N/V/headache
    • They usually diminish with subsequent doses
  • Electrolyte abnormalities - hypoK and hypoMg, renal tubular acidosis
  • Nephrotoxicity:
    • Reversible and often transient decline in GFR
    • Increase in SCr above baselinemore nephrotoxic than lipid-based formulations
    • To ameliorate GFR decline: volume expansion with 500ml of 0.9% IV sodium chloride before infusion or divided before and after
  • Anemia:
    • Reversible, normochromic, normocytic anemia
    • Onset may be delayed for as long as 10 weeks after initiation
  • Phlebitis:
    • Complication of infusions via a small peripheral vein
    • Can be minimized by infusion using a central line, use of alternating infusion sites, avoiding concentrations >0.1mg/ml and avoiding infusion times < 4 hrs
  • Main concern is concomitant nephrotoxins - use should be minimized during amphotericin therapy
  • Digoxin - increased digoxin toxicity with hypokalemia

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

If high risk of renal toxicity, consider liposomal amphotericin B formulation.

Antimicrobial class: Antifungal - polyene

Pregnancy category: B