AMPHOTERICIN B Deoxycholate
|Reviewed by Brenda
Dr Lesley Voss & Dr Elizabeth Wilson (ID Starship)
1 mg/kg/dose every 24 hours (Maximum 1.5 mg/ kg/ dose if given on alternate days)
- Approval from Infectious Diseases (ID) Team is required before starting amphotericin
- Dosing interval to be reviewed at 7 – 10 days after start of treatment
- Dosing adjustments for toxicity to be discussed with ID Team
Amphotericin B is a polyene antifungal antibiotic that is active against a
wide range of yeasts and yeast-like fungi including Candida albicans. The
mechanism of action depends on its binding to a sterol moiety, ergosterol,
present in the membrane of sensitive fungi. May be fungicidal or fungistatic,
depending on the drug concentration obtained and the sensitivity of the fungus.
Absorption from the gastrointestinal tract is negligible, even with very large doses. After IV administration only a small percentage of the drug remains in the plasma compartment. High binding (> 90%) to human plasma protein. CSF concentrations of amphotericin B are only 2-4% of the serum concentrations. Drug may accumulate in tissues to a significant concentration and be excreted renally for months.
Dosage schedules for amphotericin B have been devised following observations of toxicity with large doses and other clinical experiences. No objective data exists regarding the appropriate length of therapy required, although most infants have been treated for an average of 40 days (range 14-70 days). Amphotericin is frequently used in combination with flucytosine.
Amphotericin B deoxycholate is rarely used in children and adults due to toxicity, but neonates seem to tolerate this drug better with fewer side effects. However any neonate receiving this drug still needs close monitoring for adverse effects.
- Observe for adverse reactions during first 30 minutes of administration eg. cardiotoxicity.
- Potassium, magnesium, sodium – correct deficiencies
- Renal function – if deteriorating, discuss dosing dose regimen adjustments with ID Team, although adjustment rarely required.
- Liver function – stop therapy if abnormal.
- Full blood count
- Fluid balance