Infectious Disease Compendium

Amphotericin B (Fungizone®)

Dosing

CrCl Formula

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

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

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

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

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

Peritoneal dialysis: 0.25 to 1.5 mg/kg 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 a liter of normal saline before infusion. Ca Channel blockers and pentoxifylline work in rats. Also, give as a constant infusion over 24 hours. That will markedly reduce the toxicities.

K and Mg wasting, type 2 renal tubular acidosis.

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.

And only an asshole lets the patient know they are an ignoramus who refers to the drug as "Ampho-terrible." First, if you know what you are doing, it isn't. And second, who goes out of their way to make a patient anxious? An asshole.

The is an Amphotericin A but not an Amphotericin C.

Use for

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

Candida lusitaniae and C. auris can be intrinsically resistant.

Class

Polyene.

Curious Cases

Relevant links to my Medscape blog

Lets go out of our way to make patients anxious, shall we?

Last Update: 04/08/19.