Amphotericin B

Amphotericin B is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Amphotericin B is fungicidal by interacting with ergosterol and disrupting the fungal cell membrane. Reformulation of this agent in various lipid vehicles has decreased some of its adverse side effects. Amphotericin B formulations are not effective for Pseudallescheria boydii, Candida lusitaniae, or Aspergillus terreus infections.

  • Amphotericin B deoxycholate (0.3–1.5 mg/kg q24h as a single infusion over 2–6 hours) was once widely used but has now been supplanted by lipid-based formulations of the drug as a result of their improved tolerability.
  • Lipid complexed preparations of amphotericin B, including liposomal amphotericin B (3–6 mg/kg IV q24h) and amphotericin B lipid complex (5 mg/kg IV q24h), have decreased nephrotoxicity and are generally associated with fewer infusion-related reactions than amphotericin B deoxycholate. Liposomal amphotericin B has the most FDA-approved uses and also appears to be the best tolerated lipid amphotericin B formulation overall.

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General Principles

Amphotericin B is fungicidal by interacting with ergosterol and disrupting the fungal cell membrane. Reformulation of this agent in various lipid vehicles has decreased some of its adverse side effects. Amphotericin B formulations are not effective for Pseudallescheria boydii, Candida lusitaniae, or Aspergillus terreus infections.

  • Amphotericin B deoxycholate (0.3–1.5 mg/kg q24h as a single infusion over 2–6 hours) was once widely used but has now been supplanted by lipid-based formulations of the drug as a result of their improved tolerability.
  • Lipid complexed preparations of amphotericin B, including liposomal amphotericin B (3–6 mg/kg IV q24h) and amphotericin B lipid complex (5 mg/kg IV q24h), have decreased nephrotoxicity and are generally associated with fewer infusion-related reactions than amphotericin B deoxycholate. Liposomal amphotericin B has the most FDA-approved uses and also appears to be the best tolerated lipid amphotericin B formulation overall.

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