Antimicrobials

Active against:

• Candida species: C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei
• Aspergillus species
• Cryptococcus species
• Dimorphic Fungi (Histoplasma, Coccidiodes, Blastomyces)
• Zygomycetes
• Sporothrix

Not active against:

• Candida lusitaniae

• Empiric treatment of invasive candidiasis in critically-ill or neutropenic patients (typically second-line to less toxic agents)
• Treatment of disseminated histoplasmosis, coccidioidomycosis and blastomycosis
• Treatment of aspergillus infections (typically second-line to voriconazole)
• Treatment of cryptococcosis
• Treatment of mucormycosis

• Administration of amphotericin B may be complicated by infusion-mediated reactions (see Guidelines for management of toxicities)
• Administration of amphotericin B is commonly complicated by nephrotoxicity (see Guidelines for management of toxicities)
• Pregnancy and breastfeeding - for safety information, see Table on Safety of Anti-infective therapy in Pregnancy & Lactation

• Infusion-mediated reactions: fever, chills, rigors, headache, nausea and vomiting (lower risk with liposomal amphotericin B)
• Nephrotoxicity (lower risk with liposomal amphotericin B)
  • typically reversible upon discontinuation; increased risk of permanent toxicity with amphotericin B deoxycholate with cumulative doses > 5 g)
• Electrolyte abnormalities (hypokalemia, hypomagnesemia)
• Phlebitis
• Transamintitis
• Normochromic, normocytic anemia

• Baseline and periodic serum creatinine, transaminases, electrolytes (sodium, potassium, magnesium) and CBC

*Also see IV drug monograph on pharmacy intranet page

• Nephrotoxicity: ensure adequate hydration throughout therapy; pre-dose sodium loading may reduce the risk of nephrotoxicity
  • Infuse 500 mL of normal saline over 30 minutes before and after each daily dose to reduce the risk of nephrotoxicity
  • Consider prolonging the infusion time

• Infusion-related reactions (fever, chills, rigors):
  • Temporarily interrupt the infusion - if not resolved in 15 minutes, consider the administration of meperidine 50 mg IV diluted in 10mL NS over 5 minutes (flush with D5W before and after)
  • Hydrocortisone sodium succinate (Solu-Cortef®) 25-50 mg may be added to the infusion solution
  • Consider pre-mediation with meperidine or ibuprofen

• Phlebitis (peripheral veins):
  • Attempt to rotate IV sites regularly to minimize risk of phlebitis
  • Heparin may be added in a dose of 1 unit per mL of amphotericin B solution
  • Infusion via central venous catheter should be considered in patients not tolerating peripheral administration and particularly for infusion of more concentrated solutions (>0.1 mg/mL)