Amphotericin B

General information

Amphotericin B is a prescription drug (antimycotic) for the treatment of severe and very severe fungal infections. It is often used when the fungal infection affects the whole body (systemically), i.e. the blood and internal organs, and at the same time the number of white blood cells (leukocytes) is reduced. As a rule, this medicine should not be used for minor local fungal infections, for example in the mouth, throat or vagina. Because Amphotericin B has some side effects and is particularly aggressive, it is often used as the last drug to treat fungal infections after other, less aggressive drugs have failed.

Fields of application

Amphotericin B is mainly used for the most severe fungal infections that require treatment over several months. Cryptococcus neoformans is one of the most common fungi that cause these infections. In principle, the whole body can be affected by fungal infections.

Amphotericin B can be used for:

  • A suspected fungal infection of the entire organism,
  • Local infections of the oesophagus (esophageal candidiasis)
  • Of the meninges (meningitis)
  • Of the meninges and brain (meningoencephalitis)
  • The lungs (pneumonia)
  • Of the joints (osteoarticular candidiasis)
  • The ear pharyngeal cavity (Oropharyngeal candidiasis)
  • Of the reproductive organs and the urinary tract (Urogenital Candidiasis). Particularly in the case of infection of the meninges and brain, it is important to determine which fungus is causing the symptoms, as the dosage varies considerably. In addition, it is important to know the exact immune status of the patient and to be informed about any HIV infections, since under HIV infection the immune system is very susceptible to fungal infections and therefore the therapy with Amphotericin B must be adapted and administered for a longer period of time.

In addition to fungi, Amphotericin B is also effective against infections caused by protozoa, to which Trichonomas belongs, for example, and amoebae. Amphotericin B is not effective against bacteria or viruses. Due to the side effects of Amphotericin B (see side effects), Amphotericin B is today often given in combination with fat molecules or the body’s own fat bodies (liposomes). Although this mixture is considerably more expensive, it leads to fewer side effects than the classic Amphotericin B. In addition to fighting severe acute fungal infections, Amphotericin B is also administered to prevent fungal infections after bone marrow transplants.

Dose and intake

Before taking it, it is important to inform the treating doctor about any allergies to Amphotericin B or allergies to other medications. In addition, the attending physician must know about all other medications taken to avoid interactions and allergic reactions Amphotericin B can be administered by mouth (orally), by blood (intravenously, as an infusion) or as a cream (locally). In the case of local infections on the skin, the cream with the active ingredient can be easily applied to the skin.

As a rule, however, Amphotericin B is only used for the most severe fungal infections of the skin. Amphotericin B as a tablet only works locally in the mouth and throat and is not absorbed via the digestive tract, so it does not work in the rest of the body. In systemic infections affecting the whole body, intravenous treatment with an infusion of Amphotericin B is necessary.

The intravenous administration of Amphotericin B is highly dependent on the clinical picture. In general, depending on the severity of the clinical picture, between 0.1 and 1 mg per kilogram of body weight per day is given. For example, if one assumes a dose of 0.5 mg per kilogram of body weight per day (0.5 mg/kgkgkgkg/d), the patient would receive 40 mg of Amphotericin B in one day if he or she weighed 80 kilograms.

Amphotericin B is usually administered for 6 – 8 weeks. If Amphotericin B has to be taken over a longer period of time, the attending physician or other specialist staff can train the patient to administer the injections themselves. In the case of self-medication, the medication must never be administered if the solution is no longer crystal clear but milky or cloudy. If a dose has been missed, the attending physician should be informed in order to decide on further action.