Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- 205 Principles of antibiotic therapy
- 206 Antibacterial agents
- 207 Antifungal therapy
- 208 Antiviral therapy
- 209 Probiotics
- 210 Hypersensitivity to antibiotics
- 211 Antimicrobial agent tables
- Index
- References
207 - Antifungal therapy
from Part XXV - Antimicrobial therapy: general considerations
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- 205 Principles of antibiotic therapy
- 206 Antibacterial agents
- 207 Antifungal therapy
- 208 Antiviral therapy
- 209 Probiotics
- 210 Hypersensitivity to antibiotics
- 211 Antimicrobial agent tables
- Index
- References
Summary
This chapter focuses on the use of drugs that treat systemic mycoses (Table 207.1). Treatment of cutaneous fungal infections is discussed in Chapter 26, Superficial fungal diseases of the hair, skin, and nails.
AMPHOTERICIN B
Amphotericin B is a polyene antifungal synthesized by Streptomyces nodosus. Its chemical structure confers it with amphoteric properties that are essential for the drug’s ability to form channels through the cytoplasmatic membrane. The pores formed from preferential binding of amphotericin B to ergosterol, the primary fungal cell sterol, result in an increase in membrane permeability, leading to a loss of essential elements such as potassium and other molecules that impairs fungal viability. Amphotericin B binds with less affinity to cholesterol, the primary cell sterol of mammalian cells, which are therefore less affected by amphotericin B than is the fungal target.
Amphotericin B is commercially available as a complex with sodium deoxycholate: commercial vials contain amphotericin B, 50 mg, sodium deoxycholate, 41 mg, and a sodium phosphate buffer, 25.2 mg. The clinical pharmacology of amphotericin B is characterized by extensive binding to plasma proteins (>95%) and wide distribution to the peripheral compartment with preferential accumulation in liver and spleen, with lesser amounts in kidney and lung. Intravenous administration of therapeutic doses results in peak plasma levels of 1.0 to 1.5 μg/mL falling to 0.5 to 1.0 μg/mL 24 hours later. At therapeutic doses, less than 5% of the drug is excreted in the urine. The elimination of amphotericin B is not altered in patients with renal or liver dysfunction and does not require dose adjustment in patients who are anephric or undergoing hemodialysis.
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- Information
- Clinical Infectious Disease , pp. 1344 - 1352Publisher: Cambridge University PressPrint publication year: 2015