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Antimicrobials
Amphotericin B

Amphotericin B

Low
N/A
See Additional Information

Spectrum of Activity

General Spectrum of Activity
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General Information

  • Premedicate 30 to 60 minutes prior to drug administration with acetaminophen ± diphenhydramine or ibuprofen ± diphenhydramine

  • If patient experiences rigors during the infusion, HYDROmorphone may be administered

  • Administration of 500 to 1,000 mL of normal saline reduces the risk of nephrotoxicity

  • Renal function (BUN/SCr)

  • Electrolytes: K+, Mg++

  • LFTs

  • CBC

  • Hypotension, tachycardia, hypertension, chest pain

  • Hypokalemia, hypomagnesemia

  • Acute kidney injury

  • Injection site pain, phlebitis

  • Fever

  • Infusion-related: chills, headache, malaise

  • Diarrhea, anorexia, nausea, vomiting, abdominal pain, constipation, anorexia

  • Insomnia

  • Anxiety, confusion

  • Anemia, leukopenia, thrombocytopenia

  • Elevated LFTs

Monitor carefully with concomitant nephrotoxins

  • Deoxycholate = Fungizone IV
  • Liposomal = AmBisome

Cost:

  • Liposomal (Ambisome): $$$ ($101-$200/day)

  • Deoxycholate (Fungizone): $$ ($26-$100/day)

  • Absorption: Poor oral absorption
  • Distribution: Minimal amounts enter the aqueous humor, bile, pericardial fluid, pleural fluid, and synovial fluid
  • CNS Penetration: Poor (inflamed or noninflamed meninges)
  • Protein Binding: 90%
  • Half-Life Elimination:
    • Deoxycholate
      • Initial: 15-48 hours
      • Terminal: 15 days
    • Liposomal
      • Initial: 7-10 hours
      • Terminal: 100-153 hours
  • Time to Peak: Within 1 hour
  • Excretion: Urine (2% to 5% as biologically active form)