DRUG FOR LESHIMANIA AND
an alternative therapy for visceral
leishmaniasis, especially in parts of India with
high-level resistance to sodium
stibogluconate, but its use is limited in
developing countries by difficulty of
administration, cost and toxicity.
(Fungilin, Fungizone, Abelcet, AmBisome, Fungisome,
Amphocil, Amphotec) is a polyene antifungal
drug, often used intravenously for systemic fungal
It was originally extracted from Streptomyces
nodosus, a filamentous bacterium, in 1955 at the
Squibb Institute for Medical Research from cultures
of an undescribed streptomycete isolated from the
soil collected in the Orinoco River region of
Venezuela. Its name originates from the chemical's
Two amphotericins, amphotericin A and
amphotericin B are known, but only B is used
clinically, because it is significantly more active
in vivo. Amphotericin A is almost identical to
amphotericin B (having a double C=C bond
between the 27th and 28th carbons), but has
little antifungal activity.
Oral preparations of amphotericin B are used to
treat thrush; these are virtually non-toxic, in
contrast to typical intravenous therapy (IV) doses.
use as a drug of last resort in otherwiseuntreatable parasitic protozoan infections such as
visceral leishmaniasis and primary amoebic
• The primary site of action of amphotericin B on L. donovani
promastigote cells appears to be membrane sterols that
result in a loss of the permeability barrier to small
• Amphotericin B is highly lipophilic and easily absorbs into
membrane lipids where it interacts with membrane
sterols(cholesterol in mammals and ergosterol in fungi) to
create channels in the membrane, which allows small
molecules to be lost, eventually leading to cell death
• Inhibition of respiration by the drug was a comparatively
• Flucytosine: Toxicity of flucytosine is increased
and allows a lower dose of amphotericin B.
Amphotericin B may also facilitate entry of
flucystosine into the fungal cell by interfering
with the permeability of the fungal cell
• Diuretics : Increased renal toxicity and
increased risk of hypokalemia
• Corticosteroids: Increased risk of hypokalemia
Amphotericin B is well known for its severe
and potentially lethal side effects. Very often,
a serious acute reaction after the infusion (1
to 3 hours later) is noted, consisting of high
fever, shaking chills, hypotension, anorexia,
nausea, vomiting, headache, dyspnea and
tachypnea, drowsiness, and generalized
• It has shown efficacy for the treatment of
• Given in a dose of 2.5 mg/Kg for 28 days it
provided excellent clinical results.
• A 100 mg daily dose is recommended in
• Vomiting and diarrhea are common but
generally short-lived toxicities.
• Transient elevations in liver enzymes are also
• The drug should be avoided in pregnancy
because of its teratogenic effects.
DRUGS FOR TOXOPLASMOSIS
• Pyrimethamine plus sulphadiazine plus folinic
Why folic acid?
• Folinic acid (Leucovorin) protects the bone
marrow from the toxic effects of pyrimethamine.
What for those with sulfa allergy?
• If the patient has a hypersensitivity reaction to
sulfa drugs, pyrimethamine plus clindamycin can
be used instead.
• Management of maternal and fetal infection
varies depending on the treatment center. In
general, spiramycin is recommended (for the
first and early second trimesters) or
pyrimethamine/sulfadiazine and leucovorin
(for late second and third trimesters) for
women with acute T. gondii infection
diagnosed at a reference laboratory during