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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Amphotericin B is used for severe fungal infections where other agents are not effective and is also used to treat leishmaniasis. The liposomal formulation is mostly used due to lower side effects, but it is expensive.
Infiltrative Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aniruddha Agarwal, Sabia Handa, Vishali Gupta
Cryptococcal infection is characterized by a rapid onset of a few hours to a few days due to rapid and direct invasion of the optic nerve. Commonly, patients are already being treated with amphotericin B and/or fluconazole for cryptococcal meningitis and an increase of the dose can be effective in helping to control the optic nerve involvement. Amphotericin B may be given intravitreally and/or intravenously. This condition carries high systemic and visual morbidity and the prognosis is usually guarded.107,108
Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Amphotericin B, an antifungal agent, is used primarily to treat systemic mycotic infections. No controlled studies of amphotericin B during pregnancy are published. Review of 18 case reports suggested no evidence of teratogenicity of amphotericin B (Briggs et al., 2021).
Existing and emerging therapies for the treatment of invasive candidiasis and candidemia
Published in Expert Opinion on Emerging Drugs, 2022
David De Bels, Evelyne Maillart, Françoise Van Bambeke, Sebastien Redant, Patrick M. Honoré
A major limitation of amphotericin B is its intravenous route of administration, associated with infusion-related adverse reactions and dose-dependent renal toxicity. Amphotericin B cochleate (CAmB) has been designed for oral administration. It protects the drug from gastrointestinal degradation while maintaining the advantage of lipidic formulations to reduce nephrotoxicity. The formulation consists in a multilayered structure of negatively-charged phosphatidylserine and divalent cations (Ca2+) encapsulating the hydrophobic drug with no aqueous space in a structure resembling a cigar roll [72]. In a phase I trial published in 2009, single doses of 200–400 mg CAmB were well tolerated by healthy volunteers, but gastro-intestinal symptoms were frequent at 800 mg [72]. Results from a first phase II trial were published only 10 years later. Patients with moderate to severe candidiasis were enrolled and showed no signs of liver, kidney, or hematologic disorders were observed [73]. No difference was seen in terms of clinical and microbiological outcome or in safety between CAmB and fluconazole in another trial, with 57% success by day 12 [72].
An Iris Tumor Secondary to Talaromyces Marneffei Infection in a Patient with AIDS and Syphilis
Published in Ocular Immunology and Inflammation, 2022
Tingkun Shi, Lingjie Wu, Jinnan Cai, Haoyu Chen
Talaromyces marneffei is a fungus which was previously called Penicillium Marneffei. It is prevalent in southern China, eastern India, and Southeast Asia. It usually affects immunocompromised patients. Talaromycosis may involve the skin, lung, mouth, liver, and the whole body. The skin biopsy result of our case is consistent with the reported talaromycosis lesion in literature.9 There was a case report of vitritis and retinal abscess secondary to Penicillium marneffei in an HIV positive patient. The patient responded to intravenous and intravitreal amphotericin.10 Another article reported bilateral granulomatous anterior uveitis in a HIV-patient with disseminated Talaromycosis marneffei infection, but the lesions were small and multiple. The patient responded to intravenous and intracameral amphotericin B injection.11 Our case was a unilateral single big iris mass, which is different from the previous reports. Although amphotericin was recommended in literature as the first-line therapy, it is not available in our hospital. We used oral voriconazole and topical fluconazole without intraocular or intravenous injection. The iris and skin lesions subsided completely after anti-fungal therapy.
Transcutaneous retrobulbar injection of amphotericin B in rhino-orbital-cerebral mucormycosis: a review
Published in Orbit, 2022
Akshay Gopinathan Nair, Tarjani Vivek Dave
AMB has long been regarded as the ‘gold standard’ among antifungal drugs as it has the broadest antifungal spectrum. The clinical application of amphotericin B requires monitoring of multiple parameters, primarily due to a high incidence of infusion-related adverse events and an incidence of renal toxicity. These adverse events are mostly associated with the traditional formulation – amphotericin B deoxycholate.45 Three lipid-associated formulations were developed – amphotericin B lipid complex, liposomal amphotericin B (L-AMB), and amphotericin B colloidal dispersion to reduce the toxicity and increase efficacy as compared to conventional AMB deoxycholate.46 Hirabayashi et al. and Safi et al. used AMB deoxycholate for the TRAMB in their reported cases.38,39 Mekonnen et al. injected L-AMB into their patient's.8 The series reported by Bayram et al. included eleven cases of ROCM – all of whom received L-AMB.24 Ashraf et al. in their retrospective series, which included 26 cases of ROCM, administered the liposomal formulation to most patients.44