Ambisome 3-6mg/kg IV daily infused over several hours Discuss dosing as well as premedication with pharmacy.
Fungicidal therapy of yeast/fungus/mold infection.
Invasive candidiasis, aspergillosis, cryptococcosis.
Induction therapy for dimorphic fungii (cocci, blasto, histo).
Not for use in urinary tract infection.
Frequency depends on course, but daily reasonable during initiation
Same toxicities as conventional Amphotericin B but with less frequency.
Infusion related symptoms
HypoK and HypoMg
Loss of bicarb
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Main concern is concomitant nephrotoxins. Use should be minimized during amphotericin therapy.
Increased digoxin toxicity with hypokalemia.
Lipid associated AmB is taken up preferentially by phagocytic cells and concentrated at sites of infection while minimizing renal exposure.
Premedication with acetaminophen, diphenhydramine, or hydrocortisone are used. Meperidine may be used for rigors.
Pay careful attention to electrolyte and fluid status with boluses (usually 500mL) before and after infusion, as well as K and Mg supplementation PRN.
Antimicrobial class: Antifungal. Polyene. Lipid formulations designed to minimize toxicity.
Pregnancy category: B
Average serum half life: 150 hours
Urine penetration: Poor
Lung penetration: Therapeutic
Biliary penetration: Therapeutic