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

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 2
Aspergillus 2
Aspergillus 4
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