Antifungals- Amphotericin B
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| Drug of choice for most syste,ic mycoses | Amphotericin B
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| Used only against infections that are progressive and potentially fatal | Amphotericin B
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| Treatment time and route for Amphotericin B | Treatment is prolonged weeks to months. Why adverse reaction takes place?Absorption from GI is poor; oral therapy not effective
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| Action of Amphotericin B | Static or cidal.
Acts on fungi cell membrane (does not harm bacteria [no sterols]).
More selective to fungi than mammalian
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| Infusion reaction for Amphotericin B | Fever, Chills, Rigors, Nausea, headache.
Symptoms start in 1-3 hours and persist 1 hour.
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| Why side effects take place in Amphotericin B | Release of cytokines from monocytes and macrophages.
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| Amphotericin B: Controlling side effects | Mild reactions can be reduced by premedicating with Benadryl and ASA or acetaminophen.
Hydrocortisone can be used in severe but ruduces immune system.
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| Amphotericin B: Kidney damage | Nephrotoxicity can be reversed unless dose exceeds 4gm. Kidney damage can be minimized by infusing 1L of saline on days of therapy and avoid other nephrotoxic drugs.
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| Prototype of the azole family, broad spectrum | Ketoconazole (Nizoral)
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| Oral alternatice for amphotericin B for less sever systemic mycoses, safer, less toxic, somewhat less effective | Kretoconazole (Nizoral)
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