Amphotericin B: Difference between revisions
From IDWiki
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
== Background == |
|||
*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 |
*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 |
||
== |
===Clinical Breakpoints=== |
||
{| class="wikitable" |
{| class="wikitable" |
||
! rowspan="2" |Species |
! rowspan="2" |Species |
||
| Line 184: | Line 186: | ||
| |
| |
||
|} |
|} |
||
== 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]] |
[[Category:Polyenes]] |
||
Revision as of 14:04, 9 April 2021
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 species | 2 | ||||||||
| Aspergillus species | 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
