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IDStewardship

Amphotericin B

Amphotericin B

KEY POINTS

  • Amphotericin B is a polyene antifungal medication that binds to ergosterol and alters cell membrane permeability in susceptible fungi, causing leakage of cell components and subsequent fungal cell death
    • Amphotericin Colloidal Dispersion = ABCD
      • No longer available for purchase
    • Amphotericin B deoxycholate (conventional) = ABDC
      • General dose range is 0.3 to 1.5 mg/kg/day given once daily
    • Amphotericin B lipid (Abelcet) = ABLC
      • General dose range is 3 to 5 mg/kg/day given once daily
    • Amphotericin B liposomal (Ambisome) = L-AMB
      • General dose range is 3 to 5 mg/kg/day given once daily
  • No dose adjustment necessary for renal or hepatic dysfunction
  • When compounding IV doses, each vial comes with a filter that must be used. This means it can be a time-consuming process to compound injectable amphotericin B.
  • Broad-spectrum antifungal, which may be considered for: candidiasis, cryptococcosis, coccidiodomycosis, aspergillosis, blastomycosis, histoplasmosis, leishmaniasis or sporotrichosis
    • Can be given oral, topical, intravenous, intrathecal or inhaled
  • Some adverse events vary by product:
    • Conventional is generally considered to be worse than Abelcet or Ambisome in regards to nephrotoxicity and infusion-mediated reactions
      • Pre-Medication with normal saline boluses before and after infusions is sometimes used to try to prevent nephrotoxicity
    • Abelcet is generally considered worse than Ambisome in regards to infusion-mediated reactions (e.g., chills, rigors, flushing, vomiting, hypotension fever, tachypnea)
      • Meperidine (Demerol) is a common drug to use for rigors
      • Acetaminophen, methylprednisolone (or hydrocortisone) or diphenhydramine are sometimes given before the infusion to help prevent infusion-mediated reactions
  • It is also important to beware pain at the infusion site, hypokalemia & hypomagnesemia
  • Generally, hospitals will use ABDC in otherwise healthy young individuals and then either ABLC or L-AMB in patients at risk for nephrotoxicity or who do not tolerate ABDC
    • Hospitals typically carry ABLC or L-AMB, which is a decision made based upon cost / contracting, as these products are very similar in efficacy and toxicity

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