Infectious Disease Compendium

Amphotericin B (Fungizone®)

Dosing

CrCl Formula

CrCl > 80: 0.25 to 1.5 mg/kd q 24 h.

CrCl 80-50: 0.25 to 1.5 mg/kd q 24 h.

CrCl 50-10: 0.25 to 1.5 mg/kd q 24 h.

CrCl < 10: 0.25 to 1.5 mg/kd q 24 h.

Hemodialysis: 0.25 to 1.5 mg/kd q 24 h.

Peritoneal dialysis: 0.25 to 1.5 mg/kd 24 h.

Amphotericin B oral 1 ml (100 mg) qid po. Use for> oral Candida.

Amphotericin B lipid complex (Abelcet®) 5 mg/kg/d IV.

Amphotericin B liposomal (Ambisome®) 5-7 mg/kg/day IV.

Intrathecal? Everything you need to know is (Here.) I haven't needed to do it for over 30 years.

Important side effects

Rigors. These can be stopped with iv meperidine and Tylenol. Renal insufficiency: can be ameliorated with normal saline before infusion. Ca Channel blockers and pentoxifylline work in rats. Also, give as constant infusion over 24 hours. That will markedly reduce the toxicities. K and Mg wasting, type 2 RTA.

Hepatitis can occur in 13%.

If patients react to regular amphotericin, most will tolerate a lipid formulation (PubMed).

Important drug interactions

Concomitant other nephrotoxins will increase nephrotoxicity.

Rants and Screeds

The lipid agents, while way expensive, may be less toxic and may also be less efficacious. This whole area is a quagmire that makes the Vietnam war look straightforward and I still wonder if the bang is worth the buck.

Pearls

Treatment of choice

Use for

Fungi and yeast; for all the other moulds, yeasts and fungi, the newer imidazoles or caspofungin or both are often the treatment of choice. See the fungus in question for details.

Don't use for

Class

Polyene.