Amphotericin B deoxycholate

If a patient is non-neutropenic and has never received prior azole therapy, fluconazole 800 mg/day is an appropriate first-line therapy for invasive candidiasis until identification of the Candida isolate. Amphotericin B deoxycholate 0.7 mg/kg per day or caspofungin 70 mg on day 1, then 50 mg/day, voriconazole, or a lipid amphotericin B formulation are recommended as empiric therapy in patients with neutropenic fever. 

Amphotericin B deoxycholate 0.5-1 mg/kg IV daily Premedication with acetaminophen and diphenhydramine 500 mL normal saline boluses before and after. 

Lipid-associated formulations of amphotericin B, liposomal amphotericin B (AmBisome) and amphotericin B lipid complex (Abelcet) have been approved for use in proven cases of candidiasis however, patients with invasive candidiasis have also been treated successfully with amphotericin B colloid dispersion (Amphotec or Amphocil). The lipid-associated formulations are less toxic but as effective as amphotericin B deoxycholate. 

Lipid-based formuiations - For use in patients refractory to conventional amphotericin B deoxycholate therapy or where renal impairment or unacceptable toxicity precludes the use of the deoxycholate formulation for the treatment of invasive fungal infections (lipid complex) for the treatment of invasive aspergillosis (cholesteryl) for the treatment of infections caused by... 

Amphotericin B deoxycholate (eg, Fungizone) - 0.5 mg/kg/day administered on alternate days for 14 doses has been effective but is not recommended as primary therapy. 

Meningitis, cocc/d/o/c/a/orcAypfococca/-Administer amphotericin B deoxycholate intrathecally at initial doses of 0.025 mg, gradually increased to the maximum tolerable dose. The usual dose is 0.25 to 1 mg every 48 to 72 hours. A maximum total dose of 15 mg has been suggested. 

Lipid formulations of amphotericin B have been shown to reduce the severe kidney toxicity of amphotericin B and are indicated in patients with renal impairment or when unacceptable toxicity precludes the use of amphotericin B deoxycholate in effective doses. 

P. Chavanet, V. Joly, D. Rigaud, J. Bolard, C. Carbon, and P. Yeni, Influence of diet on experimental toxicity of amphotericin B deoxycholate, Antimicrob. Agents Chemother. 38 963-968 (1994). 

SYNS AMPHOTERICIN B DEOXYCHOLATE AMPHOTERICIN B SODIUM DESOXYCHOLATE AMPHOTERICIN B, MIXT. WITH (3-0,5-P,12-a)-3,12-DIHYDROXYCHOLAN-24-OICACIDMONOSODIUM SALT DESOXYCHOL.3.TE AMPHOTERICIN B... 

Having a broad-spectrum fungicidal activity, amphotericin remains the mainstay of treatment of most invasive fungal infections. Compared with conventional amphotericin B deoxycholate, other lipid formulations of amphotericin (amphotericin B colloidal dispersion, amphotericin B lipid complex, and liposomal amphotericin B) facilitate treatment in patients with suspected and proven invasive mycoses, who are intolerant of or refractory to conventional amphotericin. 

Edmonds LC, Davidson L, Bertino JS. Effect of variation in infusion time and macrophage blockade on organ uptake of amphotericin B-deoxycholate. J Antimicrob Chemother 1991 28(6) 919-24. 

Thakur CP, Singh RK, Hassan SM, Kumar R, Narain S, Kumar A. Amphotericin B deoxycholate treatment of visceral leishmaniasis with newer modes of administration and precautions a study of 938 cases. Trans R Soc Trop Med Hyg 1999 93(3) 319-23. 

Leenders AC, Daenen S, Jansen RL, Hop WC, Lowenberg B, Wijermans PW, Cornehssen J, Herbrecht R, van der Lelie H, Hoogsteden HC, Verbrugh HA, de Marie S. Liposomal amphotericin B compared with amphotericin B deoxycholate in the treatment of documented and suspected neutropenia-associated invasive fungal infections. Br J Haematol 1998 103(1) 205-12. 

Boogaerts M, Winston DJ, Bow EJ, Garber G, Reboli AC, Schwarer AP, Novitzky N, Boehme A, Chwetzoff E, De Beule K Itraconazole Neutropenia Study Group. Intravenous and oral itraconazole versus intravenous amphotericin B deoxycholate as empirical antifungal therapy for persistent fever in neutropenic patients with cancer who are receiving broad-spectrum antibacterial therapy. A randomized, controlled trial. Ann Intern Med 2001 135(6) 412-22. 

Garnacho-Montero J, Ortiz-Leyba C, Garcia Garmendia JL, Jimenez Jimenez F. Life-threatening adverse event after amphotericin B hpid complex treatment in a patient treated previotrsly tvith amphotericin B deoxycholate. Clin Infect Dis 1998 26(4) 1016. 

Furrer K, Schaffner A, Vavricka SR, Halter J, Imhof A, Schanz U. Nephrotoxicity of cyclosporine A and amphotericin B-deoxycholate as continnous infnsion in allogenic stem cell transplantation. Swiss Med Wkly 2002 132(23-24) 316-20. 

Eriksson U, Seifert B, Schaffner A. Comparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours randomised controlled trial. BMJ 2001 322(7286) 579-82. 

Oto OA, Paydas S, Disel U, et al. Amphotericin B deoxycholate (d-AMB) use in cases with febrile neutropenia and fungal infections lower toxicity with suitable premedication. Mycoses 2007 50 135-9. 

Lewis RE, Wiederhold NP, Prince RA, KontoyiannisDP./n v/fro pharmacodynamics of rapid versus continuous infusion of amphotericin B deoxycholate against Candida species in the presence of human serum albumin. J Antimicrob Chemother 2006 57 288-93. 

Clemons KV, Stevens DA. Comparative efficacy of amphotericin B colloidal dispersion and amphotericin B deoxycholate suspension in treatment of murine coccidioidomycosis. Antimicrob Agents Chemother 1991 35 1829-33. 

Hostetler JS, Clemons KV, Hanson LH, Stevens DA. Efficacy and safety of amphotericin B colloidal dispersion compared with those of amphotericin B deoxycholate suspension for treatment of disseminated murine cryptococcosis. Antimicrob Agents Chemother 1992 36 2656-60. 

Krejcirova L, Lauschova I, Horky D, et ai. Influence of amphotericin B deoxycholate or amphotericin B colloidal dispersion on renal tubule epithelium in rat. Biomed Pap Med Eac Univ Palacky Olomouc Czech Repub 2004 148 221-3. 

Johnson JR. Reduction of nephrotoxicity associated with amphotericin B deoxycholate. Clin Infect Dis 2004 38 303-7. 

Schneemann M, Bachli EB. Continuous infusion of amphotericin B deoxycholate a cost-effective gold standard for therapy of invasive fungal infections Clin Infect Dis 2004 38 303-4. 

Hope and coworkers [91], in studying combination therapy of antifungal drugs in the treatment of invasive candidiasis, assessed pharmacodynamic interactions of amphotericin B deoxycholate and 5-fluorocytosine. The interaction model they used was based on the Greco model of drug interaction [92] represented by the equation... 

Hope WW, Warn PA, Sharp A, Reed P, Keevil B, Louie A, et al. Surface response modeling to examine the combination of amphotericin B deoxycholate and 5-fluorocytosine for treatment of invasive candidiasis. J Infect Dis 2005 192 673-80. 

In more advanced esophageal disease, oral azoles may be ineffective. Until recently, intravenous amphotericin B deoxycholate has been the alternative for patients with endoscopically proven disease who have failed fluconazole or itraconazole therapy.22 2" Moderate disease may be treated adequately with low- to moderate-dose amphotericin B for 10 days, although higher doses may be necessary for patients with AIDS or advanced disease. " Voriconzole, a new triazole antifungal available in both oral and intravenous preparations, produces comparable clinical response to fluconazole. Voriconazole has been associated with more side effects and multiple pharmacokinetic drug interactions. " ... 

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