Amphotericin B doses

Amphotericin B doses Consider liposomal products decrease or stop CSA or TAC to minimize nephrotoxicity Remember to adjust doses of renally eliminated drugs, e.g., acyclovir, ganciclovir, TMP-SMX... 

Protect by Na" " loading, use of liposomal amphotericin B, or by drug combinations (e.g., + flucytosine), permitting in amphotericin B dose... 

There are several other examples in which berberine is combined with other substances to potentiate its antibacterial activity. Flavones, chrysosplenol-D, and chrysoplenetm from Artemisia annua L. (Asteraceae), which possess very weak antibacterial action by themselves, produce potent combinations with berberine resulting in very effective inhibition of Staphylococcus aureus growth. The combination of amphotericin B and berberine can reduce by approximately 75 % the amphotericin B dose in the treatment of candidiasis in mice, implying that berberine indeed has synergy with amphotericin B against C. albicans [104]. Another example is methicillin-resistant Staphylococcus aureus (MRSA) bacteria, which are responsible for substantial morbidity and mortality in hospitals. According to Yu et al., berberine is able to restore the effectiveness of / -lactam antibiotics... 

Potassium Iodide. When potassium iodide [7681-11-0] is adrninistered orally for several (6—8) weeks, a therapeutic effect may be obtained ia the subcutaneous form of sporotrichosis. Amphotericin B is used iatravenously to treat systemic sporotrichosis. The KI dosage is usually a saturated solution ia water (1 g/mL). The usual oral dose is 30 mg/kg/d. Children should receive five droplets, three times a day (after meals) the dose may be iacreased to 15—20 droplets. Side effects iaclude digestive disorders, swelling of the saUvary glands, and lacrimation. Thyroid function tests may be disturbed. 

A marked improvement is generally noted after 4—8 weeks of treatment. Treatment is often continued until a total dose of 3 g is reached. In the case of coccidioidomycosis, for example, treatment with 0.4—0.8 mg/kg/d may last months. The polyene is adrninistered intrathecaHy to treat Coccidioides meningitis. However, the results are only moderate. It is very important to check renal and hepatic function during treatment with amphotericin B. 

Amphotericin B-induced ARF occurs in as many as 40% to 65% of patients treated with the conventional desoxycholate formulation.30 Nephrotoxicity is due to renal arterial vasoconstriction and distal renal tubule cell damage. Risk factors include high doses, treatment for at least 7 days, preexisting kidney dysfunction, and concomitant use of other nephrotoxic drugs.31 Three lipid-based formulations of amphotericin B have been developed in an attempt to decrease the incidence of ARF amphotericin B lipid complex, amphotericin colloidal dispersion, and liposomal amphotericin B. The range of... 

Treatment of fungal IE is exceptionally difficult. There is a significant lack of studies to identify and recommend the most appropriate therapy. Currently, amphotericin B is the most common treatment. However, valve replacement surgery is often considered an adjunct therapy. Intravenous antifungal therapy requires high doses for a minimum of 8 weeks of treatment. Oral azoles (e.g., fluconazole) are used as long-term suppressive therapy to prevent relapse. The exact role of some... 

Two to three weeks of fluconazole or itraconazole solution are highly effective and demonstrate similar clinical response rates.32 Doses of 100 to 200 mg are effective in immunocompetent patients but doses up to 400 mg are recommended for immunocompromised patients. Due to variable absorption, ketoconazole and itraconazole capsules should be considered second-line therapy. In severe cases, oral azoles may prove ineffective, warranting the use of amphotericin B for 10 days. Although echinocandins and voriconazole are effective in treatment of esophageal candidiasis, experience remains limited. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Preclinical studies suggest mold-active azoles plus echinocandins have enhanced activity against Aspergillus A. terreus should be considered resistant to amphotericin B Activity of amphotericin B and voriconazole is decreased versus Aspergillus species higher doses or combination therapy may be indicated in more refractory cases... 

Itraconazole and ketoconazole (200-800 mg/day orally for 1 year) are effective in 74% to 86% of cases, but relapses are common fluconazole 200-400 mg daily is less effective (64%) than ketoconazole or itraconazole, and relapses are seen in 29% of responders Severe disease Amphotericin B 0.7 mg/kg/day for a minimum total dose of 35 mj kg is effective in 59% to 100% of cases and should be used in patients who require hospitalization or are unable to take itraconazole because of drug interactions, allergies, failure to absorb drug or failure to improve clinically after a minimum of 12 weeks of itiaconazole therapy... 

All patients with disseminated blastomycosis and those with extrapulmonary disease require therapy (ketoconazole, 400 mg/day orally for 6 months). CNS disease should be treated with amphotericin B for a total cumulative dose greater than 1 g. 

Patients may be initiated on amphotericin B and changed to oral itraconazole 200-400 mg orally daily once patient is clinically stabilized and a minimum dose of 500 mg of amphotericin B has been administered. 

In patients intolerant of azoles or in whom disease progresses during azole therapy Amphotericin B 0.5-0.7 mj kg/day IV (total dose 1.5-2.5 g). 

Amphotericin B 0.7-1 Patients without CNS infection may be switched to itracon-mg/kg/day IV (total azole once clinically stabilized and a minimum dose of... 

Isolated pulmonary disease (without evidence of CNS infection) Asymptomatic disease Drug therapy generally not required observe carefully or fluconazole 400 mg orally daily x 3-6 months Mild to moderate symptoms Fluconazole 200-400 mg orally daily x 3-6 months severe disease or inability to take azoles amphotericin B 0.4-0.7 mg/kg/day (total dose of 1-2 g)... 

In patients who cannot tolerate voriconazole, amphotericin B can be used. Full doses (1 to 1.5 mg/kg/day) are generally recommended, with response measured by defervescence and radiographic clearing. The lipid-based formulations may be preferred as initial therapy in patients with marginal renal function or in patients receiving other nephrotoxic drugs. The optimal duration of treatment is unknown. 

Amphotericin B 0.7 mg/kg/day IV for a minimum of 2 weeks with or without flucytosine 100 m kg/day orally in four divided doses (Al) followed by... 

Amphotericin B (AmB) is a broad-spectrum antifungal agent that is the antibiotic of choice for disseminated fungal infections, particularly in immunocompromised patients. AmB is also used for the treatment of Leishmaniasis as a second-line treatment. However, its toxicity toward mammalian cells is often dose limiting, whatever its indication. 

Flucytosine is converted in Candida fungi to 5-fluorouracil by the action of a specific cytosine deaminase. As an antimetabolite, this compound disrupts DNA and RNA synthesis (p. 298), resulting in a fungicidal effect Given orally, flucytosine is rapidly absorbed. It is well tolerated and often combined with amphotericin B to allow dose reduction of the lattet... 

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