antibioticsbooks

172 PART 4 Antifungal Drugs
Spectrum
Good: most species of Candida and Aspergillus,
Cryptococcus neoformans, dimorphic fungi,
many molds
Moderate: Zygomycetes
Poor: Candida lusitaniae, Aspergillus terreus
Adverse Effects
Infusion-related reactions: Infusion-related reactions
with amphotericin B products include
fever, chills, and rigors, and can be impressive.
They can be attenuated by premedicating with
acetaminophen, hydrocortisone, and sometimes
other medications. Liposomal amphotericin
B has the least serious infusion-related
reactions; amphotericin B colloidal dispersion
has the worst.
Renal: Nephrotoxicity with amphotericin B products
is common. Both direct effects on the
distal tubule and indirect effects through vasoconstriction
of the afferent arteriole cause the
nephrotoxicity, and nephrotoxicity also leads to
wasting of magnesium and potassium, which
thus need supplementation. All of the lipid
formulations have less nephrotoxicity than
the conventional amphotericin B deoxycholate
formulation; liposomal amphotericin B has the
least.
Others: Increased transaminases and rash can
occur with amphotericin B products as well.
Dosing Issues
The multiple formulations of amphotericin B can
lead to confusion over their dosing. Amphotericin
B deoxycholate is generally dosed between 0.5 and