Amphotericin B/Fungizone : Wheeless' Textbook of Orthopaedics

- for severe systemic fungal infections;
- dose: 0.25mg/kg IV over 6hrs initially (infusion .1mg/ml);
- gradually increase dose as tolerated up to 1-1.5mg/kg/24hrIV over 6hr;
- note hypersensitivity, caution with nephrotoxic/antineoplastic agents;
- monitor blood, liver, and renal function,
- discontinue therapy if BUN >40mg/dl, Creatinine >3.0mg/dl, or if liver function test abnormalities are noted;
- should be delivered via Central Line;
- pretreatment with ASA, acetaminophren, and antihistamines (Benadryl) helps minimize adverse effects;
- small amounts of heparin (1unit/ml) and hydrocortisone (2.5mg/mg Ampho) added to the infusion may help minimize phlebitis;
- may consider 1mg test dose over 30min;
- may also apply as a cream to supperficial Candida;
- may also cause hypokalemia, fever;
- note diffusion from Blood into CSF is NIL even w/ Inflammation;
- dosing regimens for patients with Renal Insufficiency: (Dose for 70kg Adult {gm/dosing interval in hours}):
CrCl:>80:0.02-0.05/24; CrCl:50-79:0.02-0.05/24; CrCl:30-49:0.02-0.05/24; CrCl:10-29:0.02-0.05/24;
- 40% of drug excreted in urine over 7 days;
- will interact with aminoglycosides (Incrnephrotoxicity), digitalis and neuromuscular blocking agents (due to Ampho induced Hypokalemia);
- note: may cause HypoMagnesemia;
- mixture interactions references