Amphotericin B (AMB)

It is active against a wide range of yeasts and fungi, Candida albicams, Histoplasma Capsulatan, Cryptococcus neoformans, Blactomyces dermatitidis, Coccidioides, inmitis, Torulopsis, Rhodotorula, Aspergillus, Sporothrix. It is fungicidal at high and static at low concentrations.

Indications

Topically for oral, vaginal and cutaneous candidiasis and otomycosis. Most effective for various types of systemic mycoses. Intravenously for treatment of progressive and potential fatal fungal infections, intestinal moniliasis.

Dosage

Orally- 50-100 mg four times. For Systemic mycoses, Initially 1 mg test dose is injected over 20 mins i.v. followed by 0.3 mg/kg body wt is infused over 4-8hrs. Max of 0.7 mg/kg body wt.

Contra-Indications

Renal impairment, epilepsy.

Special Precautions

Test dose is must before giving intravenously. Adverse reactions can decrease with inclusion of hydrocortisone 0.6 mg/kg body wt in the infusion. Paediatrics: Reduced dose may be necessary. Pregnancy: No evidence of risk. Lactation: No evidence of risk. Elderly: Safe.

Side Effects

Chills, fever, aches, nausea, vomiting and dyspnoea. Thromboflebitis of the injected vein. Nephrotoxicity, (azotemia, reduced g.f.r, acidosis, hypokalemia and inability to concentrate urine). Anaemia due to bone marrow depression. C.N.S. toxicity.

Drug Interactions

Potentiation of potassium loss by corticosteroids, increases digital toxicity, causes hypokalemia with diuretics, antagonism with ketoconazole, aminoglycosides enhance renal toxicity, induce renal toxicity enhanced in presence of other nephrotoxic agents.