Amphotericin B: Difference between revisions

From IDWiki
(Imported from text file)
 
No edit summary
 
(8 intermediate revisions by the same user not shown)
Line 1: Line 1:
  +
== Background ==
−
= Amphotericin B =
  
   
−
* Last choice of antifungal due to side effect profile, but effective
 +
*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
  
  +
*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===
  +
{| class="wikitable"
  +
! rowspan="2" |Species
  +
! rowspan="2" |ECV (μg/mL)
  +
! colspan="4" |Breakpoints (μg/mL)
  +
! colspan="4" |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
  +
|—
  +
| colspan="2" rowspan="6" |
  +
|—
  +
| colspan="4" rowspan="6" |
  +
|-
  +
|[[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]]
  +
  +
[[Category:Polyenes]]

Latest revision as of 09:01, 22 October 2024

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

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
Retrieved from "https://idwiki.org/index.php?title=Amphotericin_B&oldid=10908"
Powered by MediaWiki
Powered by Semantic MediaWiki