Amphotericin B
From IDWiki
Background
- Last choice of antifungal due to side effect profile, but effective
- Binds to ergosterol in fungal cell membrane and creates pores that cause leakage of monovalent ions
- Causes renal dysfunction, among other things
Spectrum of Activity
- Very broad antifungal
- However, there is often non-susceptibility with Candida auris, Candida lusitaniae, Sporothrix, Fusarium, Scedosporium, and Aspergillus terreus
Clinical Breakpoints
| Species | ECV (μg/mL) | Breakpoints (μg/mL) | Breakpoints (mm) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| S | SDD | I | R | S | SDD | I | R | ||
| Candida albicans | 2 | ||||||||
| Candida dubliniensis | |||||||||
| Candida glabrata | 2 | ||||||||
| Candida guilliermondii | |||||||||
| Candida krusei | 2 | ||||||||
| Candida lusitaniae | |||||||||
| Candida parapsilosis | 2 | ||||||||
| Candida tropicalis | 2 | ||||||||
| Cryptococcus neoformans | 0.5 | ||||||||
| Cryptococcus gattii | 0.5-1 | ||||||||
| Aspergillus flavus | 4 | — | — | ||||||
| Aspergillus fumigatus | 1 | ≤1 | >1 | ||||||
| Aspergillus nidulans | 4 | — | — | ||||||
| Aspergillus niger | 0.5 | ≤1 | >1 | ||||||
| Aspergillus terreus | 8 | — | — | ||||||
| Aspergillus versicolor | 2 | — | — | ||||||
Dosing
Amphotericin B Deoxycholate (Conventional)
- Usual dose: 0.3 to 1.5 mg/kg IV daily
- Disseminated aspergillosis: 0.6 to 0.7 mg/kg IV daily for 3 to 6 months
- Blastomycosis: 0.7 to 1 mg/kg IV daily for 1 to 2 weeks followed by itraconazole
- Candidiasis
- CNS infection: 0.01 to 0.5 mg/2mL in D5W intraventricularly
- Endophthalmitis: 5 to 10 mcg/0.1 mL intravitreally
- Esophageal: 0.3 to 0.7 mg/kg IV daily
- Invasive: 0.5 to 0.7 mg/kg IV daily; consider higher dosing up to 1 mg/kg for Candida glabrata or Candida krusei
- Oropharyngeal: 100 mg suspended in 1 mL 4 times daily
- Urinary tract infection:
- Cystitis: 0.3 to 0.6 mg/kg IV daily for 1 to 7 days
- Pyelonephritis: 0.3 to 0.6 mg/kg IV daily for 1 to 7 days, with or without flucytosine
Liposomal Amphotericin B (AmBisome)
- Usual dose: 3 to 6 mg/kg IV daily
- Aspergillosis: 3 to 5 mg/kg IV daily; up to 7.5 mg/kg for CNS infections
- Candidiasis:
- Candidemia: 3 to 5 mg/kg IV daily
- CNS: 5 mg/kg IV daily
- Hepatosplenic: 3 to 5 mg/kg IV daily
- Invasive: 3 to 5 mg/kg IV daily
- Endocarditis: 3 to 5 mg/kg IV daily +/- flucytosine
- Endophthalmitis: 3 to 5 mg/kg IV daily +/- flucytosine
- Osteomyelitis: 3 to 5 mg/kg IV daily
- Septic thrombophlebitis: 3 to 5 mg/kg IV daily
- Coccidiomycosis:
- Disseminated with HIV: 3 to 4 mg/kg IV daily with flucytosine
- Meningitis with HIV: 3 to 4 mg/kg IV daily with flucytosine
- Fungal sinusitis: 3 to 10 mg/kg IV daily
- Histoplasmosis
- Acute pulmonary: 3 to 5 mg/kg IV daily for 1 to 2 weeks, followed by itraconazole
- Disseminated: 3 mg/kg IV daily for 2 weeks, followed by itraconazole
- Meningitis: 5 mg/kg IV daily for 4 to 6 weeks, followed by itraconazole
