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Administering amphotericin B--a practical approach
S H Khoo1, J Bond, D W Denning
1Regional Department of Infectious Diseases and Tropical Medicine, Monsall Hospital, Manchester, UK.
Abstract:
Despite the introduction in recent years of novel antifungal agents, the potency and broad spectrum of activity of amphotericin B have ensured that it remains the treatment of choice for most deep-seated mycoses. However, this agent is not without significant toxicity, particularly in patients who are already seriously ill and/or who are receiving other potentially nephrotoxic drugs. We review the various routes by which amphotericin B can be administered, focusing mainly on the intravenous route. The use of more rapid infusion rates, lipid-complexed preparations, sodium supplementation in salt-depleted patients and strategies to reduce the incidence of infusion-related reactions and nephrotoxicity are also considered. Finally, detailed recommendations for the administration of amphotericin B are provided.
Insights
Amphotericin B remains a vital antifungal treatment for deep mycoses due to its effectiveness. This review details administration strategies to minimize toxicity and improve patient outcomes.
Area of Science:
- Mycology
- Pharmacology
- Infectious Diseases
Background:
- Amphotericin B is a cornerstone antifungal agent for deep-seated mycoses.
- Despite its efficacy, amphotericin B is associated with significant toxicity, especially in critically ill patients or those on nephrotoxic medications.
Purpose of the Study:
- To review administration routes for amphotericin B.
- To discuss strategies for mitigating amphotericin B-related toxicity and infusion reactions.
Main Methods:
- Review of intravenous administration of amphotericin B.
- Consideration of rapid infusion rates and lipid-complexed formulations.
- Evaluation of sodium supplementation and other supportive measures.
Main Results:
- Amphotericin B's broad spectrum and potency make it essential for treating severe fungal infections.
- Strategies exist to reduce infusion-related reactions and nephrotoxicity.
- Optimized administration can improve patient tolerance and safety.
Conclusions:
- Amphotericin B remains a critical treatment for deep mycoses.
- Careful administration and toxicity management are crucial for patient safety.
- Recommendations for amphotericin B administration are provided to guide clinical practice.