What Is Amphotericin B?
Amphotericin B is a polyene antifungal drug. Fungi that are sensitive to this product include new types of cryptococcus, dermatitis bacillus, histoplasma, coccidia, sporothrix, candida, etc., some Aspergillus are resistant to this product; skin and trichophyton Most are resistant. This product has no antimicrobial activity against bacteria, rickettsiae, and viruses. The drug concentration reached by the commonly used therapeutic amount has only antibacterial effect on fungi.
Basic Information
- Drug Name
- Amphotericin B
- Foreign name
- Amphotericin B
- Adverse reactions
- A chill occurred hours after the drip
- Molecular formula
- C47H73NO17
- Molecular weight
- 924.07902
- Character
- Orange-yellow needle-like or columnar crystals
Amphotericin B indication
- Used for visceral or systemic infections caused by cryptococcus, coccidioids, capsular histoplasma, spores, mycelia, candida, mucor, aspergillus, etc.
Amphotericin B clinical application
- 1. Intravenous drip Start with a small dose, generally increase by 1mg, 3mg, 5mg, 10mg, and gradually increase the dose to 0.7mg / (kg · d). The initial dose increase should be slow, and the increase rate can be appropriately increased when the patient's response is not obvious. Dissolve amphotericin B in 500ml 5% glucose injection at each dose, and complete the drip within 6 to 8 hours. Select glucose injection at pH 5.5. If the stability of the main drug decreases when the pH is lower than pH 5.3, the pH value can be adjusted by sodium bicarbonate injection if the pH is low. When the response of the patient is obvious, it can be antagonized with a small dose of glucocorticoid (such as dexamethasone 1 ~ 2mg). In order to prevent chills and high fever, 1/3 of indomethacin suppository can be given to the rectum 20-30 minutes before administration. Amphotericin B is unstable to light, and should be protected from light during infusion. Liver and kidney function and electrolytes should be monitored during medication. The total amount of amphotericin B is generally 2 ~ 3g.
- 2. Atomization inhalation
- For lung and bronchial infections. 5 10mg a day, dissolved in 100 200ml water for injection, divided into 4 times;
- 3. Local lesion injection
- Concentration 1 ~ 3mg / ml, once every 3 ~ 7 days, if necessary, a small amount of procaine injection can be added; for fungal empyema and arthritis, 5 ~ 10mg can be injected after local extraction of pus, 1 weekly ~ 3 times.
Amphotericin B adverse reactions
- It is more toxic, and may have fever, chills, headache, loss of appetite, nausea, and vomiting. Intravenous medication can cause thrombophlebitis, and intrathecal injection can cause back and lower limb pain. It has a damaging effect on the kidney, which can cause proteinuria and cast urine. When regular inspection shows that urea nitrogen> 20mg / dl or creatinine> 3mg / dl, measures should be taken to stop or reduce the dose. There are still reactions such as leukopenia, anemia, decreased or increased blood pressure, liver damage, diplopia, peripheral neuritis, and rash. During the trial period, an increase in heart rate and even ventricular fibrillation may be caused by the concentration of the injected drug solution being too high, the speed being too fast, the dosage being too large, and the patient's hypokalemia.
Amphotericin B considerations
- Hypokalemia may occur during the use of this product, and it should be given high attention and timely potassium supplementation. This product is easily degraded in strong acidic medicine, and the pH value of the glucose injection used is 5.5. This product is more toxic and may have adverse reactions such as fever, nausea and vomiting. Intrathecal injection can cause back and lower limb pain; it can cause kidney damage such as proteinuria. It should be checked regularly. Urea nitrogen> 20mg / dl or creatinine> 3mg / When dl, the drug should be stopped or the dose should be reduced. There are also decreased white blood cells, decreased or increased blood pressure, liver damage, diplopia, peripheral neuritis, and rash. During use, the heart rate may increase, and even ventricular fibrillation may be caused by the concentration of the injected drug solution being too high, the speed being too fast, the dosage being too large, and the patient's hypokalemia. During the treatment period, blood, urine routine, liver, kidney function, potassium, ECG, etc. should be closely followed regularly. If the blood urea nitrogen or blood creatinine is significantly increased, the treatment should be reduced or suspended until renal function recovers.
Amphotericin B contraindications
- Allergic to this product, severe liver disease patients are prohibited. Patients with liver and kidney dysfunction should be used with caution.
Amphotericin B drug interactions
- 1. Combined with flucytosine, the efficacy of the two drugs is enhanced, but the toxicity of flucytosine is enhanced.
- 2. When combined with adrenocortical hormones, it may aggravate hypokalemia induced by amphotericin B.
- 3. Combining this product with azole antifungal drugs can reduce the antibacterial efficacy.
- 4. Combined with other nephrotoxic drugs, such as aminoglycosides, antitumor drugs, vancomycin, etc., can aggravate nephrotoxicity.
- Note: The above content is only for introduction, the drug use must be carried out by a regular hospital under the guidance of a doctor.