Amphotericin B

Amphotericin B remains the most common choice for the treatment of systemic fungal infection. It is a polyene which acts by increasing the permeability of the fungal cell membrane. It is highly tissue bound, particularly in the liver, spleen, kidney, and lung. No dose modification is necessary in renal or hepatic failure. Amphotericin B is not removed by hemodialysis. The first 1 mg of a dose may be given over 1 h to assess adverse effects, followed by 49 mg over 6 h. The dose should then be 1 mg/kg/day from the following day.

Treatment of aspergillosis in the profoundly neutropenic patient is often unsuccessful. Amphotericin is often used to treat acute cryptococcal meningitis. Adverse effects are renal failure, fever, chills, headache, hypotension, phlebitis, hypokalemia, anemia, and hepatitis. Liposomal, lipid complex, and colloidal dispersion amphotericin B have been produced to reduce toxicity. High doses can be given safely, but they may be less potent and are only indicated in a patient with previous adverse reactions or renal impairment. Candida tropicalis may be resistant.

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