Fungal disease amphotericin

Fatal fungal diseases Amphotericin B is frequently the only effective treatment for potentially fatal fungal diseases. Balance its possible lifesaving effect against its dangerous side effects. 

For treatment of systemic fungal disease, amphotericin B is given by slow intravenous infusion at a dosage of 0.5-1 mg/kg/d. It is usually continued to a defined total dose (eg, 1-2 g), rather than a defined time span, as used with other antimicrobial drugs. 

Amphotericin (nonliposomal) - Do not use to treat noninvasive forms of fungal diseases. Exercise caution to prevent inadvertent overdose. 

Systemic fungal diseases (e.g. histoplasmosis and blastomycosis) are uncommon but, if untreated, often fatal. They usually take the form of lung infections or meningitis. The best treatment is still the polyene antibiotic, amphotericin B 5.14) whose mode of action is described in Section 5.4.1 (p. 192). It is usually administered intravenously. Flucytosine 4.23) is an excellent synergist (Section 4.0, p. 131), seldom given alone. Intravenous miconazole 6.23) provides alternative therapy, but there are frequent adverse reactions. An orally active analogue, ketoconazole ( Nizoral ) was introduced in 1981, and looks promising. 

Some rare, but often fatal, systemic fungal diseases, such as histoplasmosis and North American blastomycosis yield to injections of amphotericin B (5.7, p. 166), but its selectivity is only moderate (for mode of action, see Section 14.2). A related substance, nystatin, is used for superficial candiasis and for those infections of the gut with Candida albicans that sometimes follow tetracycline therapy. 

Lopez-Berestein, G. (1989). Treatment of systemic fungal infections with liposomal-amphotericin B, in Liposomes in the Therapy of Infectious Diseases and Cancer (G. Lopez-Berestein and I. J. Fidler, eds.), Alan R. Liss, New York, pp. 317-327. 

Fungal infections of the gastrointestinal tract can result in serious diarrhoea. The macrolides amphotericin B (51) and nystatin (52) are used to control this disease in pigs and poultry respectively. 

Headache is common during the immediate infusion reaction. Neuropathy, convulsions, tremor, and paresis have also been attributed to amphotericin. It is difficult to assess these reports, because in systemic fungal infections, with the possibility of central nervous system involvement, the symptoms may be due to the underlying disease. 

For many years, fungal infections were classified as either superficial nuisance diseases, such as athlete s foot or vulvovaginal candidiasis, or as relatively rare infections confined primarily to endemic areas of the country. When invasive fungal infections were encountered, amphotericin B was the only consistently effective, systemi-cally active agent available for the treatment of systemic mycoses. 

Clinical Experience - Amphotericin B continued to be the drug of choice in treatment of serious or systemic fungal infections. It was reported earlier that while either 2-hydroxystilbamidine or amphotericin B was effective in treatment of noncavltary pulmonary blastomycosis, the latter drug was the more effective agent in treatment of this infection in those cases with cavitary disease or with systemic organ involvement.Amphotericin B also was described as useful in the treatment of canine blastomycosis. 

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