Amphotericin

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Amphotericin B is a polyene antifungal agent.

first isolated by Gold et al from Streptomyces nodosus in 1955. It is an amphoteric compound composed of a hydrophilic polyhydroxyl chain along one side and a lipophilic polyene hydrocarbon chain on the other. Amphotericin B is poorly soluble in water [2049].

Amphotericin B is now available in four formulations. The classic amphotericin B deoxycholate (Fungizone™) formulation has been available since 1960 and is a colloidal suspension of amphotericin B. A bile salt, deoxycholate, is used as the solubilizing agent.



Side-Effects

The most commonly observed infusion-related side effects of amphotericin B deoxycholate are fever, chills, and myalgia. These can be partially overcome by premedication with diphenhydramine and/or acetaminophen [802].

Nephrotoxicity is the major adverse effect limiting the use of amphotericin B. The manifestations of nephrotoxicity are azotemia, decreased glomerular filtration, loss of urinary concentrating ability, renal loss of sodium and potassium, and renal tubular acidosis [1397]. The renal injury reduces erythropoietin production and leads to a normochromic normocytic anemia [1232].

Thrombophlebitis may occur at the site of infusion. Thrombocytopenia may rarely be observed [379].