Drug

Amphotericin B

General

Amphotericin B is a prescription drug (Antifungal agent) to treat severe and very severe fungal infections.
It is often used when the fungal infection affects the whole body (systemic), i.e. the blood and internal organs, and at the same time the number of white blood cells (Leukocytes) is reduced.
The drug should not usually be used for minor local fungal infections, such as in the mouth, throat, or vagina.
Because amphotericin B has some side effects and is particularly aggressive, it is often used as the last drug to fight fungal infections after other, less aggressive agents have failed.

application areas

Amphotericin B is mainly used at severe fungal infections that have to be treated over several months.
One of the most common fungi that cause these infections is one Cryptococcus neoformans.
In principle, the whole body can be affected by fungal infections. Amphotericin B can be used for:

a suspicion of a Fungal infection of the whole organism,
local infections of the esophagus (Oesophageal candidiasis)
of the Meninges (meningitis)
of the meninges and des Brain (Meningoencephalitis)
of the lung (pneumonia)
of the Joints (Osteoarticular candidiasis)
the Pharynx (Oropharyngeal candidiasis)
of the Genital organs and the lower urinary tract (Urogenital candidiasis).

In the case of infections of the meninges and the brain in particular, it is important to prove which fungus is causing the symptoms, since the dose varies considerably.

In addition, it is important that Immune status of the patient to know exactly and about any existing HIV infections to be informed, as with HIV infection the immune system is very susceptible to fungal infections and therefore the therapy with amphotericin B has to be adapted and administered longer.

Besides mushrooms, amphotericin B is also at Protozoal infections, including Trichonomas, and at Amoeba effective.
Amphotericin B has no effect against bacteria or viruses.

Because of the side effects of Amphotericin B (see Side Effects), Amphotericin B is used today often combined with fat molecules or the body's own fat bodies (liposomes) given. Although this mixture is significantly more expensive, it has fewer side effects than the classic amphotericin B.

In addition to fighting severe acute fungal infections, Amphotericin B is also used to Prevention of fungal infections after bone marrow transplants administered.

Dose and intake

Before taking it is important to inform the attending physician about any existing Allergies to amphotericin B or Allergies against other drugs to inform. In addition, the attending physician must be aware of all other medications taken in order to avoid interactions and allergic reactions

Amphotericin B can over the mouth (orally), about the blood (intravenous, as an infusion) or as a cream (local) can be administered.
In the case of local infections on the skin, the cream with the active ingredient can simply be applied to the skin. As a rule, however, amphotericin B is only used for the most severe fungal infections of the skin.
Amphotericin B as a tablet only works locally in the mouth and throat and is not absorbed via the digestive tract, so it does not work in the rest of the body.
Systemic infections affecting the whole body require intravenous treatment via an infusion of amphotericin B.

When amphotericin B is administered intravenously, the dose used depends heavily on the clinical picture.
In general, depending on the severity of the clinical picture, there is between 0.1 and 1 mg per kilogram of body weight per day. Assuming, for example, a dose of 0.5 mg per kilogram of body weight per day (0.5 mg / kg body weight / day), the patient with a weight of 80 kg would receive 40 mg of amphotericin B per day.
Usually amphotericin B for 6 - 8 weeks administered.
If amphotericin B has to be taken over a long period of time, the treating doctor or other specialist staff can train the patient to administer the injections himself. In the case of self-medication, the drug must not be administered under any circumstances if the solution is no longer crystal clear, but milky or cloudy. If a dose is missed, the attending physician should be informed in order to decide how to proceed.

Side effects

Amphoterin B can very many different side effects cause and therefore should only after strict indications and can only be taken at the agreed doses.
The severity of the side effects depends on the type of Amphotericin B.
In the case of ointments and tablets, it can usually only be too local symptoms how itching, Swelling or Blistering While amphotericin B is administered intravenously, many different side effects can be observed.

The very common (> 10%) side effects with taking amphotericin B include:

flu-similar symptoms with or without fever, hoarseness, Difficulty breathing
Rash, itching, red, puffy, or blistered skin
Swelling of the face
Pain and cramps in the Gastrointestinal tract, nausea (Nausea) and Vomit (Vomiting), diarrhea (Diarrhea), Loss of appetite
a headache
Hearing loss
low Blood pressure
Racing heart
Potassium deficiency
Muscle and joint pain

If the following side effects occur, the doctor should be contacted immediately:

Allergic reactions up to anaphylactic shock,
Seizures
Cardiac arrhythmias
black discolored stool
Urination disorders, very dark urine
Rapid breathing
Hearing loss
yellowish discoloration of the skin and conjunctiva
very severe diarrhea
Listlessness
severe redness or swelling at the injection site.

From taking amphotericin B it can cause a Damage to kidney function come. That is why the Blood and especially kidney values checked closely become. If the kidney function worsens during therapy with amphotericin B, but at the same time further treatment is unavoidable, the dose can be reduced to 50%, but must then be given over a longer period.

Contraindications

Amphotericin B should not in case of known allergy to amphotericin B If there is acute suspicion, close medical monitoring should be carried out during the first dose.
During the pregnancy Amphotericin B should only be given if there are no medical alternatives, as a possible teratogenic effects of amphotericin B could not yet be ruled out.