Antimicrobials
Amphotericin B - Lipid Associated

Amphotericin B - Lipid Associated

Low
N/A

Spectrum of Activity

Dosing

General Information

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. (Use conventional amphotericin B in UTI)

  • 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.

  •  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

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

Increased digoxin toxicity with hypokalemia.

Lipid associated Amphotericin B 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.

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

Average serum half life: 150 hours

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic