From the Guidelines
Amphotericin B is 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 1. The conventional formulation (amphotericin B deoxycholate) is typically administered intravenously at 0.5-1.5 mg/kg/day, while lipid-based formulations allow for higher dosing (3-5 mg/kg/day) with reduced toxicity 1. Some key points to consider when using Amphotericin B include:
- Treatment duration varies from weeks to months depending on infection severity and patient response
- Common side effects include infusion-related reactions (fever, chills, rigors), nephrotoxicity, electrolyte abnormalities (particularly hypokalemia), and anemia
- To minimize adverse effects, premedication with acetaminophen, diphenhydramine, and sometimes corticosteroids is recommended, along with adequate hydration and careful monitoring of renal function and electrolytes 1
- Amphotericin B works by binding to ergosterol in fungal cell membranes, creating pores that disrupt membrane integrity and lead to cell death
- Its broad spectrum of activity and fungicidal nature make it valuable for critically ill patients, though newer azole and echinocandin antifungals are often preferred when possible due to amphotericin's toxicity profile
- For patients with mild-to-moderate disease, the drug can be initiated at doses of 0.25--0.5 mg/kg, and then increased as tolerated to 0.5--1.5 mg/kg/day 1
- For patients with life-threatening disease, the target daily dose should be administered from the beginning 1
- Amphotericin B lipid formulations have a role among children who are intolerant of amphotericin B, have disseminated candidal infection that is refractory to conventional amphotericin B, or are at high risk for nephrotoxicity because of pre-existing renal disease or use of other nephrotoxic drugs 1
From the FDA Drug Label
Amphotericin B for Injection USP should be administered primarily to patients with progressive, potentially life-threatening fungal infections. This potent drug should not be used to treat noninvasive fungal infections, such as oral thrush, vaginal candidiasis and esophageal candidiasis in patients with normal neutrophil counts 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 used to treat potentially life-threatening fungal infections, including:
- Aspergillosis
- Cryptococcosis
- North American blastomycosis
- Systemic candidiasis
- Coccidioidomycosis
- Histoplasmosis
- Zygomycosis
- Sporotrichosis 2
From the Research
Amphotericin B Overview
- Amphotericin B is an antifungal medication used to treat severe fungal infections, including those caused by Candida and Aspergillus species 3, 4.
- It is available in various formulations, including a lipid complex and a colloidal dispersion, which were developed to reduce the nephrotoxicity associated with the conventional form of the drug 3, 5.
Efficacy and Safety
- Studies have shown that amphotericin B is effective in treating fungal infections in patients with compromised immune systems, such as bone marrow transplant recipients and solid-organ transplant recipients 3, 4.
- The lipid-based formulations of amphotericin B have been found to have a reduced propensity for causing nephrotoxicity, making them a safer option for patients at high risk of renal dysfunction 4, 5.
- Clinical response rates to amphotericin B treatment have been reported to be around 50-60% in patients with proven fungal infections 3, 4.
Comparison with Other Antifungal Agents
- Amphotericin B has been compared to other antifungal agents, such as fluconazole, in clinical trials 6.
- While there were no significant differences in effect between amphotericin B and fluconazole, the confidence intervals were wide, and the trials had some methodological limitations 6.
- Amphotericin B is considered a valuable option for the treatment of systemic fungal infections, particularly in cases where other agents are not effective or are contraindicated 7.
Clinical Use
- Amphotericin B is often used as a second-line treatment for patients who cannot tolerate or fail an adequate trial of conventional antifungal therapy or cannot benefit from other antifungal agents 5.
- The choice of antifungal agent depends on various factors, including the type of fungal infection, the patient's underlying medical condition, and the potential for drug interactions and adverse effects 7.