Antimicrobials
Amphotericin - Lipid Associated

Amphotericin - Lipid Associated

Low
N/A
$$$$

Spectrum of Activity

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)

Laboratory

  • Daily Cr, K, Mg
  • Weekly LFTs and CBC

Clinical

  • Infusion-related effects
  • Lower incidence of nephrotoxicity than amphotericin B deoxycholate
  • Infusion-related effects
  • Electrolyte disturbances (hypokalemia, magnesemia)

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.

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 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Poor