Name of the Antimicrobial Drugs Cause leakage from Cell membranes
- Polymyxin
- Colistin
- Bacitracin
- Amphotericin B
1.Polymyxin
| Polymyxin |
| Indications and Dosages To treat infections resistant to less toxic drugs, such as bacteremia, septicemia, and UTI caused by susceptible organisms, including Enterobacter aerogenes, Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae I.V. INFUSION Adults and children age 2 and over. 15,000 to 25,000 units/kg daily in divided doses every 12 hr or as a continuous infusion. Maximum: 2 million units daily. Infants and children under age 2. Up to 40,000 units/kg daily in divided doses every 12 hr or as a continuous infusion. I.M. INJECTION Adults and children age 2 and over. 25,000 to 30,000 units/kg daily in divided doses every 4 to 6 hr. Maximum: 2 million units daily. Infants and children under age 2. Up to 40,000 units/kg daily in divided doses every 4 to 6 hr To prevent bacteriuria and bacteremia in patients with an indwelling catheter BLADDER IRRIGATION Adults and children age 2 and over. Combination of 200,000 units (20 mg) polymyxin B sulfate and 57 mg neomycin sulfate added to 1,000 ml normal saline solution daily as a continuous bladder irrigation for up to 10 days; rate adjusted as prescribed, based on patient’s urine output To treat meningitis caused by susceptible strains of Pseudomonas aeruginosa or H. influenzae INTRATHECAL INJECTION Adults and children age 2 and over. 50,000 units daily for 3 to 4 days, then 50,000 units every other day for at least 2 wk after CSF cultures are negative and glucose content is normal. Infants and children under age 2. 20,000 units daily for 3 to 4 days, then 25,000 units every other day for at least 2 wk after CSF cultures are negative and glucose content is normal. |
Mechanism of Action
Binds to cell membrane phospholipids in gram-negative bacteria, increasing permeability of cell membrane. Polymyxin B also acts as a cationic detergent, altering osmotic barrier of membrane and causing essential intracellular metabolites to leak out. Both actions lead to cell death
Contraindications
Hypersensitivity to polymyxin B or its components
Adverse Reactions
- CNS: Ataxia, confusion, dizziness, drowsiness, fever, giddiness, headache, increased leukocyte and protein levels in CSF, neurotoxicity, paresthesia (circumoral or peripheral), slurred speech
- CV: Thrombophlebitis
- EENT: Blurred vision, nystagmus
- GU: Albuminuria, azotemia, cylindruria, decreased urine output, hematuria, nephrotoxicity
- HEME: Eosinophilia
- RESP: Respiratory muscle paralysis
- SKIN: Rash, urticaria
- Other: Anaphylaxis, drug-induced fever, facial flushing, injection site pain, stiff neck (with intrathecal injection), superinfection
Nursing Considerations
- Be aware that patients receiving polymyxin B sulfate are hospitalized to allow appropriate supervision.
- Obtain blood, urine, or other samples for culture and sensitivity tests, as ordered, before giving drug. Expect to start drug before results are known. Keep in mind that baseline renal function tests should have been performed before administration. Check test results, if available, and notify prescriber of abnormalities.
- For I.M. injection, reconstitute sterile powder with 2 ml of sterile water for injection or sodium chloride for injection.
- Be aware that I.M. route isn’t usually recommended (especially for infants and children) because it can cause severe pain at injection site
2.Colistin
| Colistin |
| Availability powder for injection 150mg/via |
| Indications and Dosages To treat acute or chronic gram-negative infections caused by Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa I.M. INJECTION, I.V. INJECTION, I.V. INFUSION Adults. 2.5 to 5 mg/kg daily in 2 to 4 divided doses. Maximum: 5 mg/kg/day. |
Mechanism of Action
Penetrates into and disrupts bacterial cell membrane, resulting in cell death. Colistimethate is an inactive pro-drug of the bioactive form colistin. Colistin binds to gram-negative bacterial cell membrane phospholipids, increasing cell membrane permeability and causing loss of metabolites essential to bacterial existence.
Pharmacokinetics
- Protein Bound: 50%
- Metabolism: colistimethate sodium hydrolyzed in vivo
- Metabolites: colistin (active)
- Excretion: urine
- Dialyzable: unknown
- Peak plasma Time: 2 hr (IM)
Contraindications
- Hypersensitivity to colistimethate or its components, renal disease
- For I.V. infusion, dissolve polymyxin B in 300 to 500 ml of D5W and infuse over 60 to 90 minutes.
- For intrathecal route, add 10 ml sodium chloride for injection to polymyxin B vial.
- Inspect for particles and discoloration before giving drug.
- During therapy, monitor renal function, including BUN and serum creatinine levels, especially in patients with a history of renal insufficiency
- Assess for signs of superinfection, such as mouth sores, severe diarrhea, and white patches on tongue or in mouth, especially in debilitated or elderly patients.
- Monitor fluid intake and output and provide adequate fluids to reduce the risk of nephrotoxicity.
Pharmacokinetics
- Protein Bound: 79-92%
- Half-life elimination: 4.3-6 hr with normal renal function
- Metabolism: N/A
- Excretion: urine 60% (<1% as unchanged drug)
- Peak plasma Time: IM: 2 hr
Adverse Reactions
- CNS: Dizziness, fever, paresthesia, slurred speech, tingling of extremities, vertigo
- GI: Nausea, pseudomembranous colitis, vomiting
- GU: Decreased creatinine clearance and urine output, increased BUN and serum creatinine, nephrotoxicity
- MS: Muscle weakness
- RESP: Apnea, respiratory distress SKIN: Pruritus, rash, urticaria
Nursing Considerations
- Use colistimethate cautiously in patients with impaired renal function.
- Reconstitute each 150-mg vial with 2 ml sterile water for injection to yield 75 mg/ ml. During reconstitution, swirl vial gently to avoid frothing.
- When giving by I.V. injection, slowly inject half of total daily dose over 3 to 5 minutes and repeat dose 12 hours later, as ordered.
- When giving by I.V. infusion, slowly inject half of total daily dose over 3 to 5 minutes. Then add remaining half of total daily dose to an appropriate solution, such as normal saline solution or D5W, with type and amount of solution dictated by patient’s fluid and electrolyte needs. Starting 1 to 2 hours after first dose, slowly infuse remaining drug over 22 to 23 hours.
- If patient has renal impairment, use a reduced infusion rate. Once the infusion is prepared, use within 24 hours.
- Notify prescriber if patient develops neurologic changes (paresthesia, tingling of limbs, pruritus, vertigo, dizziness, slurred speech). Dosage may need to be reduced.
- Monitor patient receiving drug I.M. because apnea and neuromuscular blockade may occur with this route, especially in patients with impaired renal function. Before giving drug I.M., make sure dose is appropriate for degree of renal function.
- Monitor patient’s bowel elimination. If diarrhea develops, obtain stool culture to check for pseudomembranous colitis. If confirmed, expect to stop drug and give fluid, electrolytes, and antibiotics effective against Clostridium difficile.
Patient Teaching
- Caution patient to avoid performing hazardous activities, including driving, during colistimethate therapy.
- Tell patient to immediately report tingling in her extremities, vertigo, dizziness, generalized pruritus, or slurred speech because dosage may need to be decreased.
- Explain need for frequent blood tests during therapy to check kidney function.
- Urge patient to tell prescriber about diarrhea that’s severe or lasts longer than 3 days. Remind patient that watery or bloody stools can occur 2 or more months after antibiotic therapy and can be serious, requiring prompt treatment
3.Bacitracin
| Bacitracin |
| Indications and Dosages To treat pneumonia and empyema caused by susceptible staphylococci I.M. INJECTION Infants weighing more than 2.5 kg (5.5 lb). 1,000 units/kg daily in 2 or 3 divided doses. Infants weighing less than 2.5 kg. 900 units/ kg daily in 2 or 3 divided doses. |
Mechanism of Action
Interferes with bacterial cell wall synthesis by binding with isoprenyl pyrophosphate (a lipid-carrying molecule that transports substances out of bacterial cells to help build new cell walls), forming an unusable complex in bacterial cells. This weakens cell walls and causes lysis and death. Bacitracin is considered bacteriostatic and bactericidal.
Adverse Reactions
- GI: Nausea, vomiting
- GU: Albuminuria, azotemia, cylindrical mucus casts in urine, nephrotoxicity
- SKIN: Rash
- Other: Injection site pain, superinfection
Contraindications
Hypersensitivity or toxic reaction to bacitracin
Nursing Considerations
- Obtain culture and sensitivity test results before therapy begins, if possible. Be prepared to start bacitracin therapy before results are available.
- For I.M. solution of 5,000 units/ml, reconstitute 50,000 units bacitracin powder with 9.8 ml sodium chloride for injection that contains 2% procaine hydrochloride
- Administer I.M. injection into upper outer quadrant of buttocks, alternating between right and left sides. To prevent pain at injection site, avoid giving multiple injections in same site.
- During therapy, compare daily results of renal function tests with baseline results, as appropriate.
- Assess urine output often (hourly, if needed), and replace fluids orally and parenterally to maintain adequate renal function.
- Assess infant for signs of superinfection, especially white patches in mouth and perineum. If superinfection develops, plan to treat with appropriate antibiotics.
Patient Teaching
- Advise parents that daily blood tests are needed to assess infant’s renal function.
- Encourage parents to provide oral fluids to promote renal function. Teach them how to record infant’s fluid intake.
- Instruct parents to report signs or symptoms of superinfection, such as white patches in mouth or perineal area and bright red diaper rash.
4.Amphotericin B
| Amphotericin B |
| Availability Amphotericin B cholesteryl sulfate— Injection: 50 mg, 100 mg Amphotericin B desoxycholate— Injection: 50-mg vial Oral suspension: 100 mg/ml in 24-ml bottles Amphotericin B lipid complex— Suspension for injection: 100 mg/20-ml vials Amphotericin B liposome— Injection: 50 mg |
| Indications and dosages Invasive aspergillosis Adults: Amphotericin B desoxycholate—For patients with good cardiorenal function who tolerate test dose, give 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours). Gradually increase to 0.5 to 0.6 mg/kg daily. Patients with neutropenia or rapidly progressing, potentially fatal infections may require higher dosages (1 to 1.5 mg/kg daily). Adults and children ages 1 month and older: Amphotericin B liposome—3 to 5 mg/kg I.V. daily Invasive aspergillosis in patients with renal impairment or unacceptable toxicity who can’t tolerate or don’t respond to amphotericin B desoxycholate in effective doses Adults and children: Amphotericin B cholesteryl sulfate—3 to 4 mg/kg daily reconstituted in sterile water for injection and diluted in dextrose 5% in water (D5W) and give by continuous infusion at 1 mg/kg/hour. Amphotericin B lipid complex—5 mg/kg daily I.V. prepared as 1-mg/ml infusion and delivered at a rate of 2.5 mg/kg/hour Systemic histoplasmosis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.5 to 0.6 mg/kg daily I.V. for 4 to 8 weeks; higher dosages (0.7 to 1 mg) may be necessary for rapidly progressing, potentially fatal infections Systemic coccidioidomycosis and blastomycosis Adults: Amphotericin B desoxycholate— If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.5 to 1 mg/kg daily I.V. for 4 to 12 weeks Systemic cryptococcosis Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.3 to 1 mg/kg daily I.V. (with or without flucytosine) for 2 weeks to several months. For patients with human immunodeficiency virus (HIV) infection, usual dosage is 0.7 mg/kg daily I.V. for 4 weeks, followed by 0.7 mg/kg I.V. given on alternate days for 4 additional weeks. If patient can’t tolerate or doesn’t respond to amphotericin B desoxycholate, give amphotericin B cholesteryl sulfate at a dosage of 3 to 6 mg/kg daily I.V. Adults and children ages 1 month and older: Amphotericin B liposome—3 to 5 mg/kg daily I.V Cryptococcal meningitis in HIVinfected patients Adults: Amphotericin B desoxycholate— If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.3 to 1 mg/kg daily I.V. (with or without flucytosine) for 2 weeks to several months. Amphotericin B lipid complex—5 mg/kg I.V. infusion daily for 6 weeks, followed by 12 weeks of oral fluconazole therapy. Amphotericin B liposome—6 mg/kg I.V. infusion daily. Disseminated candidiasis Adults: Amphotericin B desoxycholate— If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.4 to 0.6 mg/kg daily by slow I.V. infusion for 7 to 14 days (low-risk patients) or for 6 weeks (high-risk patients). For hepatosplenic candidiasis, 1 mg/kg daily I.V. given with oral flucytosine; for severe or refractory esophageal candidiasis in HIV-infected patients, 0.3 mg/kg daily I.V. for at least 5 to 7 days; for candiduria, 0.3 mg/kg daily I.V. for 3 to 5 days. Adults and children ages 1 month and older: Amphotericin B liposome—3 to 5 mg/kg/day I.V. for 5 to 7 days Systemic zygomycosis, including mucormycosis Adults: Amphotericin B desoxycholate— If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 1 to 1.5 mg/kg daily I.V. for 2 to 3 months. For rhinocerebral phycomycosis form, total dosage is 3 g I.V Systemic disseminated sporotrichosis Adults: Amphotericin B desoxycholate— If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.4 to 0.5 mg/kg daily I.V. for 2 to 3 months Cutaneous leishmaniasis Adults and children: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.5 mg/kg/day given by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) until 0.5 to 1 mg/kg/day is reached; then give every other day. Usual duration is 3 to 12 weeks. Visceral leishmaniasis in immunocompetent patients Adults and children ages 1 month and older: Amphotericin B liposome— 3 mg/kg given I.V. over 2 hours on days 1 through 5, 14, and 21. Repeat course if initial treatment fails to clear parasites Visceral leishmaniasis in immunocompromised patients Adults and children ages 1 month and older: Amphotericin B liposome—4 mg/ kg given I.V. over 2 hours on days 1 through 5, 10, 17, 24, 31, and 38 Empiric therapy for presumed fungal infection in febrile, neutropenic patients Adults: Amphotericin B desoxycholate—If patient tolerates test dose, gradually increase from initial recommended dosage of 0.25 to 0.3 mg/kg daily by slow I.V. infusion (0.1 mg/ml over 2 to 6 hours) to usual dosage of 0.25 to 1 mg/kg daily I.V. Amphotericin B liposome—3 mg/kg daily given I.V. over 120 minutes for 2 weeks. |
Mechanism of Action
Binds to sterols in fungal cell plasma membranes, which changes membrane permeability and allows loss of potassium and small molecules from cells. This action results in cell impairment or death
Pharmacokinetics
- Half-Life: 7-10 hr (at 24 hr); terminal half-life range 10-153 hr
- Vd: 0.1-0.4 L/kg
- AUC: 27-555 mcg•h/mL
- Peak Plasma Concentration: 7.3-83 mcg/mL
- Clearance: 11-51 mL/hr/kg
Contraindications
- Hypersensitivity to drug and its components
- Severe respiratory distress
Precautions:
- renal impairment, electrolyte abnormalities
- pregnant or breastfeeding patients
- children.
Administration
- Know that amphotericin B should be given only by health care professionals thoroughly familiar with drug, its administration, and adverse reactions.
- Before giving first dose of conventional amphotericin B (desoxycholate form), test dose may be ordered (due to widely varying tolerance and clinical status) as follows: 1 mg in 20 ml of D5W over 20 to 30 minutes; monitor vital signs every 30 minutes for next 2 hours.
- Know that if desoxycholate form is discontinued for 1 week or longer, drug should be restarted at 0.25 mg/kg daily, with dosage then increased gradually.
- Pretreat with antihistamines, antipyretics, or corticosteroids, as prescribed.
- Give through separate I.V. line, using infusion pump and in-line filter with pores larger than 1 micron.
- Choose distal vein for I.V. site. Alternate sites regularly.
- Mix with sterile water to reconstitute. Don’t mix with sodium chloride, other electrolytes, or bacteriostatic products.
- Flush I.V. line with 5% dextrose injection before and after infusion.
- Keep dry form of drug away from light. Once mixed with fluid, solution can be kept in light for up to 8 hours.
- Know that total daily dosage of amphotericin B desoxycholate form should never exceed 1.5 mg/kg.
Adverse reactions
- CNS: anxiety, confusion, headache, insomnia, weakness, depression, dizziness, drowsiness, hallucinations, speech difficulty, ataxia, vertigo, stupor, psychosis,seizures
- CV: hypotension, hypertension, tachycardia, phlebitis, chest pain, orthostatic hypotension, vasodilation, asystole, atrial fibrillation, bradycardia, cardiac arrest, shock, supraventricular tachycardia
- EENT: double or blurred vision, amblyopia, eye hemorrhage, hearing loss, tinnitus, epistaxis, rhinitis, sinusitis, pharyngitis
- GI: nausea, vomiting, diarrhea, melena, abdominal pain, abdominal distention, dry mouth, oral inflammation, oral candidiasis, anorexia, GI hemorrhage
- GU: painful urination, hematuria, albuminuria, glycosuria, excessive urea buildup, urine of low specific gravity, nephrocalcinosis,renal failure, renal tubular acidosis, oliguria, anuria
- Hematologic: eosinophilia; normochromic, normocytic, or hypochromic anemia; leukocytosis; thrombocytopenia; leukopenia; agranulocytosis; coagulation disorders
- Hepatic: jaundice, acute hepatic failure, hepatitis
- Metabolic: hypomagnesemia, hypokalemia, hypocalcemia, hypernatremia, hyperglycemia, dehydration, hypoproteinemia, hypervolemia, hyperlipidemia, acidosis
- Musculoskeletal: muscle, joint, neck, or back pain
- Respiratory: increased cough, hypoxia, lung disorders, hyperventilation, wheezing, dyspnea, hemoptysis, tachypnea, asthma, bronchospasm, respiratory failure, pulmonary edema, pleural effusion
- Skin: discoloration, bruising, flushing, pruritus, urticaria, acne, rash, sweating, nodules, skin ulcers, alopecia, maculopapular rash
- Other: gingivitis, fever, infection, peripheral or facial edema, weight changes, pain or reaction at injection site, tissue damage with extravasation, hypersensitivity reactions including anaphylaxis
Patient monitoring
- Monitor for infusion-related reactions (fever, chills, hypotension, GI symptoms, breathing difficulties, and headache). Stop infusion and notify prescriber immediately if reaction occurs.
- After giving test dose, monitor vital signs and temperature every 30 minutes for 2 to 4 hours, as ordered.
- Assess fluid intake and output.
- Monitor kidney and liver function test results and serum electrolyte levels.
- Assess for signs and symptoms of ototoxicity (hearing loss, tinnitus, ataxia, and vertigo).
Patient teaching
- Advise patient to contact prescriber immediately if he has fever, chills, headache, vomiting, diarrhea, cough, or breathing problems.
- Instruct patient to report hearing loss, dizziness, or unsteady gait.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision.
- Instruct patient to drink plenty of fluids.
- Tell patient to monitor urine output and report significant changes.
- Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
Nursing Considerations
- To prepare amphotericin B, add 10 ml of sterile water for injection without a bacteriostatic agent to vial containing 50 mg of amphotericin B. For I.V. infusion, dilute solution containing 5 mg/ml to 0.1 mg/ml by adding 1 ml (5 mg) of solution to 49 ml of D5W with a pH above 4.2.
- Before using D5W to dilute amphotericin B solution, determine the injection’s pH aseptically. If pH is below 4.2, follow manufacturer’s instructions for buffering it.
- Because reconstituted amphotericin B is a colloidal suspension, avoid using in-line membrane filter or use one with a mean pore diameter of more than 1 micron to prevent significant drug removal.
- To prepare amphotericin B cholesteryl sulfate complex, reconstitute with sterile water for injection. Using a sterile syringe and 20G needle, rapidly add 10 or 20 ml sterile water for injection to a 50- or 100- mg vial, respectively, to obtain a solution containing 5 mg of amphotericin B per milliliter. Shake gently by hand, rotating vial until solids are dissolved; fluid may be clear or opalescent. For infusion, further dilute reconstituted solution to about 0.6 mg/ml. Don’t filter solution or use an in-line filter. Flush existing line with D5W or use a separate line.
- To prepare amphotericin B lipid complex, shake vial gently until you see no yellow sediment. Using an 18G needle, withdraw prescribed dose from required number of vials into one or more 20-ml syringes. Replace needle with 5-micron filter needle supplied with each vial. Empty syringe contents into bag of D5W so that final concentration is 1 mg/ml. Expect to use a concentration of 2 mg/ml for children and patients with cardiovascular disease. Before infusion, shake bag until contents are mixed thoroughly. Flush existing line with D5W, or use a separate line. Don’t use an in-line filter. If infusion exceeds 2 hours, shake infusion bag every 2 hours.
- To prepare amphotericin B liposomal complex, add 12 ml sterile water for injection (without bacteriostatic agent) to each 50-mg vial to achieve a concentration of 4 mg amphotericin B per milliliter. Immediately shake vial vigorously for at least 30 seconds until all particles completely disperse. Withdraw prescribed dose of amphotericin B liposomal complex suspension. Then use a 5-micron filter to inject it into D5W to provide a final concentration of 1 to 2 mg/ml. Expect to use a lower concentration (0.2 to 0.5 mg/ ml) for infants and young children. Flush existing line with D5W, or use a separate line. You may use an in-line filter with a mean pore diameter of at least 1 micron.
- To help minimize fever and shaking chills, expect to give an antipyretic, antihistamine, meperidine, or corticosteroid just before infusing amphotericin B.
- Before giving amphotericin B oral suspension, shake well. Drop suspension on tongue with calibrated dropper. Then tell patient to swish suspension in mouth for as long as possible before swallowing. If drug must be swabbed on, use a nonabsorbent swab.
- Give amphotericin B oral suspension between meals to permit prolonged contact with oral lesions.
- Assess I.V. insertion site regularly to detect extravasation of amphotericin B, which may cause severe local irritation. To minimize local thrombophlebitis, plan to add heparin to infusion or expect to administer amphotericin on alternate days, which also may help prevent anorexia. Alternateday dose shouldn’t exceed 1.5 mg/kg.
- Monitor renal function because of the risk of renal impairment. Plan to obtain serum creatinine level every other day while amphotericin B dosage is increasing and then at least twice weekly during therapy. If serum creatinine or BUN level increases significantly, expect to stop amphotericin B until renal function improves. Know that a cumulative dose of more than 4 g may cause irreversible renal dysfunction.
- Expect to monitor CBC and platelet count weekly during therapy to detect adverse hematologic effects. Also monitor serum calcium, magnesium, and potassium levels twice weekly to detect abnormalities.
- Use reconstituted amphotericin B within 24 hours if stored at room temperature, 1 week if refrigerated. Use reconstituted amphotericin B cholesteryl sulfate complex within 24 hours. Use amphotericin B lipid complex within 6 hours if stored at room temperature, 48 hours if refrigerated. Use diluted amphotericin B liposomal complex within 24 hours if refrigerated but begin infusion within 6 hours. PA
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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