Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

AMPHOTERICIN B LIPOSOMAL (AmBisome ® )Infectious Disease approval required for all use of AmBisome ® (see Appendix I)Usual DoseAdult and pediatric: 3-5 mg/kg once daily IV (UWHC cost/day $253.64-$423.15)1. Fungal infections in adult patients who satisfy at least one of the following criteria:a. Baseline serum creatinine 1.5 to 2.0 mg/dL.b. Intolerance to current treatment with conventional amphotericin B as indicated by a rise in serum creatinine to2.0-2.5 mg/dL (in adults).c. Failure of treatment with conventional amphotericin B as indicated by persistent positive cultures and/or clinicaljudgment after receiving at least 1 g of therapy.d. Use in very fragile or hemodynamically unstable patients with known or suspected fungal infections, who are atgreater risk for nephrotoxicity with conventional amphotericin B.2. Aspergillus or other fungal infections of the CNS.3 Immunocompromised patients with systemic fungal infections.CommentsAcute infusion reactions occasionally occur with liposomal amphotericin . Acute infusion reactions usually occur 1-3 hoursafter starting the infusion. These reactions are generally more severe with initial doses and usually diminish withsubsequent doses. To avoid fever and rigors with liposomal amphotericin, an antihistamine (e.g., diphenhydramine 25-50mg PO/IV) and an antipyretic (e.g., acetaminophen 650 mg PO) should be given 30 minutes before the infusion. Serumcreatinine should be monitored closely with liposomal amphotericin therapy. Infusion of 500 mL normal saline before andafter liposomal amphotericin infusion may prevent or slow renal toxicity. Treatment of serious Aspergillus or other invasivemold infections may require doses up to 10 mg/kg. Idiosyncratic lung-related liposome agglutination reactions are alsopossible under rare circumstances.See guidelines for use on uconnectSee Guidelines for Use of Antifungal Therapy (Appendix E) or on uconnectAMPICILLINUsual DoseAdult: Mild infections 250-500 mg Q6H IV/IM (UWHC cost/day $2.36-4.71)Moderate/severe infections 1-2 g Q4-6H IV/IM (UWHC cost/day $9.42-28.28)Meningitis, septicemia 8-14 g/day in divided doses Q3-4H IVPediatric** 100 mg/kg/day IV (meningitis 200-400 mg/kg/day IV) in divided doses Q4-6HIndications1. Urosepsis, cholangitis or bacteremia due to Escherichia coli, Proteus mirabilis or Enterococcus spp. (If Enterococcus,combine with low-dose gentamicin outside the urinary tract).2. Neonatal meningitis given with gentamicin.3. Listeria meningitis/sepsis, usually combined with gentamicin.4. Ampicillin-susceptible Haemophilus influenzae meningitis.5. Shigellosis, salmonellosis or typhoid fever due to susceptible strains.6. Endocarditis due to slow-growing, fastidious Gram-negative organisms (HACEK group), in combination withgentamicin.7. Use for the same indications as amoxicillin when a parenteral drug is needed.8. Bacterial endocarditis prophylaxis (see Appendix A).CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Oral ampicillin is non-formulary, but is preferred over oral amoxicillin for ampicillin-susceptible shigellosis. Resistanceamong Salmonella and Shigella (especially in patients who have been traveling) has made ampicillin a second-line agentfor these infections unless the infecting strain is documented susceptible. Avoid use of ampicillin-class antibiotics inpatients with mononucleosis due to high risk of development of erythematous rash and erroneous allergy attribution.