From the Guidelines
Amphotericin B is first-line treatment for severe, life-threatening fungal infections, particularly invasive fungal diseases such as cryptococcal meningitis, invasive aspergillosis, mucormycosis, and disseminated candidiasis in critically ill patients. The evidence from 1 supports the use of conventional amphotericin B (sodium deoxycholate complex) as the drug of choice for most invasive candidal infections in children, with a recommended regimen of 0.5--1.5 mg/kg administered once daily intravenously.
Key Points
- The typical dosing for conventional amphotericin B deoxycholate is 0.5-1.5 mg/kg/day intravenously, while lipid formulations are dosed at 3-5 mg/kg/day 1.
- Treatment duration typically ranges from 2-6 weeks depending on the infection type and severity, often followed by an oral antifungal for consolidation therapy.
- Amphotericin B works by binding to ergosterol in fungal cell membranes, creating pores that lead to cell death.
- Despite newer antifungals, it remains essential for severe fungal infections due to its broad spectrum and fungicidal activity, though its use requires careful monitoring for side effects like nephrotoxicity, electrolyte abnormalities, and infusion reactions.
Considerations
- The use of lipid formulations of amphotericin B, such as amphotericin B lipid complex (ABLC) and liposomal amphotericin B, may be considered in patients who are intolerant of conventional amphotericin B or have disseminated candidal infection that is refractory to conventional amphotericin B 1.
- The evidence from 1 suggests that caspofungin, an echinocandin antifungal agent, may be an effective alternative to amphotericin B for the treatment of invasive candidiasis, particularly in patients with fluconazole-resistant infections.
Monitoring and Precautions
- Patients receiving amphotericin B should be closely monitored for signs of nephrotoxicity, electrolyte abnormalities, and infusion reactions 1.
- Premedication with acetaminophen or diphenhydramine may be used to alleviate febrile reactions associated with amphotericin B infusion 1.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: aspergillosis, cryptococcosis (torulosis), North American blastomycosis, systemic candidiasis, coccidioido-mycosis, histoplasmosis, zygomycosis including mucormycosis due to susceptible species of the genera Absidia, Mucor and Rhizopus, and infections due to related susceptible species of Conidiobolus and Basidiobolus, and sporotrichosis.
Amphotericin B is first-line treatment for:
- Aspergillosis
- Cryptococcosis (torulosis)
- North American blastomycosis
- Systemic candidiasis
- Coccidioido-mycosis
- Histoplasmosis
- Zygomycosis (including mucormycosis)
- Sporotrichosis 2
From the Research
Amphotericin B as First-Line Treatment
Amphotericin B is considered a first-line treatment for various invasive fungal infections, including:
- Febrile neutropenia 3
- Disseminated histoplasmosis 3
- Cryptococcal meningitis, particularly in patients with AIDS 3, 4, 5
- Invasive Candida spp. or Aspergillus spp. infections 3
- Systemic fungal infections, due to its low incidence of antifungal resistance and high efficacy against a wide range of fungi 6, 7
Infections Treated with Amphotericin B
Some specific infections treated with amphotericin B include:
- Candidiasis 3, 6, 7
- Aspergillosis 3, 6, 7
- Fusariosis 3
- Zygomycosis 3
- Histoplasmosis 3, 5
- Cryptococcal meningitis 3, 4, 5
Combination Therapies
Amphotericin B can be used in combination with other antifungal agents, such as: