Systematic drug interaction studies have not been performed to date using amphotericin B cholesteryl sulfate complex, amphotericin B lipid complex, or amphotericin B liposomal. The fact that drug interactions reported with conventional IV amphotericin B could also occur with these lipid-based or liposomal formulations of the drug should be considered.
Acute infusion reactions (e.g., fever, chills, headache, nausea, vomiting) and nephrotoxicity are the most frequent adverse reactions to conventional IV amphotericin B. Although clinical experience with amphotericin B cholesteryl sulfate complex, amphotericin B lipid complex, and amphotericin B liposomal is limited to date, these drugs appear to be better tolerated than conventional IV amphotericin B.
Conventional amphotericin B is administered by IV infusion. The drug also has been given intra-articularly, intrapleurally, intrathecally, or by local instillation or irrigation. For information regarding administration of the drug as an oral suspension and administration of the drug topically, subconjunctivally, or by local instillation or irrigation.
Conventional IV amphotericin B (formulated with sodium desoxycholate) is used for the treatment of potentially life-threatening fungal infections including aspergillosis, North American blastomycosis, systemic candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, paracoccidioidomycosis,, sporotrichosis, and zygomycosis.
Caspofungin acetate, a semisynthetic lipopeptide synthesized from a fermentation product of Glarea lozoyensis, is an echinocandin antifungal agent. The drug is a glucan synthesis inhibitor and differs structurally and pharmacologically from other currently available antifungal agents. Caspofungin inhibits the synthesis of b(1,3)-d-glucan, an integral component of the fungal cell wall that is not present in mammalian cells.
Terbinafine hydrochloride is a synthetic allylamine antifungal agent. Terbinafine is structurally and pharmacologically related to naftifine.
Quinupristin and dalfopristin is a combination of 2 semisynthetic streptogramin (synergistin) antibiotics that act synergistically against susceptible gram-positive bacteria.
Quinupristin and dalfopristin is administered by IV infusion over 60 minutes. Quinupristin and dalfopristin powder for injection must be reconstituted and diluted prior to administration. The manufacturer states that only 5% dextrose injection or sterile water for injection should be used to reconstitute the powder, and further dilution should be with 5% dextrose. Strict aseptic technique must be observed since the drug contains no preservative.
Systemic use of polymyxin B has, in most cases, been replaced by more effective and less toxic antibiotics for infections caused by susceptible organisms. However, polymyxin B may be useful in infections caused by organisms resistant to these drugs.
Colistimethate sodium is used in the treatment of acute or chronic infections caused by susceptible strains of certain gram-negative bacteria (e.g., Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa).