Amphotericin B and other

In spite of the overwhelming importance of the channel mechanism for the transport of alkali and alkaline earth metal ions in biological systems, only carrier transport has been studied extensively by chemists. Studies on ion channel mimics of simple structures have long been limited to antibiotic families of gramicidin, amphotericin B, and others. Several pioneers have reported successful preparation of non-peptide artificial channels. However, their claims have been based on kinetic characteristics observed for the release of metal ions through liposomal membrane and lacked the very critical proofs of channel formation. Such a situation was... 

Indications Treatment of the invasive aspergillosis in patients who are refractory to or intolerant of other therapies (i.e., amphotericin B, lipid formulations of amphotericin B. and/or itraconazole). 

Macrolides. Antibiotics in the macrolide group are macrocyclic lactones that can be further classified into two main subgroups (I) polyene macrolides that are antifungal agents and include compounds like nystatin and amphotericin B and (2) antibacterial antibiotics represented by erythromycin and tylosin. A number of other subfamilies of antibacterial and antifungal antibiotics fall into the broad category of macrolides,... 

Mycosamine differs from most of the other amino sugars isolated from antibiotic substances in not being V-methylated.86 The tetraacetate XXVI of mycosamine (XXV) can be isolated by acetolysis of nystatin or of the antifungal antibiotic substance amphotericin B, and it yields the acetamido derivative XXVII on catalytic deacetylation. 

A rabbit model for Candida albicans compared the efficacy of topical amphotericin B with four other antifungal agents. Amphotericin B and 5% natamycin were the most effective, 1% miconazole and 1% flucytosine were effective but inferior to the polyenes, and 1% ketoconazole was not effective (O Day et al.). 

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. 

Two other antibiotics that destroy membranes, amphotericin B and nystatin, are large ring structures that are used in treating serious systemic fungal infections. These antibiotics... 

Fluconazole is the drug of choice for treatment of coccidioidal meningitis because of much less morbidity than with intrathecal amphotericin B. In other forms of coccidioidomycosis, fluconazole is comparable to itraconazole. Fluconazole has activity against histoplasmosis, blastomycosis, sporotrichosis, and ringworm, but response is less than with equivalent doses of itraconazole. Fluconazole is not effective in the prevention or treatment of aspergillosis. As with other azoles, with the possible exception of posa-conazole, there is no activity in mucormycosis. 

The effects of amphotericin B and azole antifungals would be expected to be antagonistic, and there is some clinical evidence to support this suggestion of reduced efficacy, and even increased adverse effects. However, other studies suggest that the combination of amphotericin B and fluconazole may be beneficial. 

Other predicted interactions of tacrolimus include additive neuro- or nephrotoxicity with aciclovir, aminoglycosides, co-trimoxazole, ganciclovir, gyrase inhibitors, NSAIDs (see NSAIDs , (p.1081)) or vancomycin (nephrotoxicity has been seen with amphotericin B and tacrolimus). ... 

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