Amphotericin B: Time for a New “Gold Standard”

• Published in: Clinical infectious diseases Vol. 37; no. 3; pp. 415 - 425
• Main Authors: Saravolatz, Louis D., Ostrosky-Zeichner, Luis, Marr, Kieren A., Rex, John H., Cohen, Stuart H.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.08.2003; University of Chicago Press
• Subjects: Amphotericin B - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - therapeutic use; Antifungals; Antiparasitic agents; Aspergillosis; Aspergillus; Biological and medical sciences; Chemistry, Pharmaceutical; Clinical trials; Clinical Trials as Topic; Dosage; Drug Carriers; Drug Delivery Systems; Fever; Fungal infections; Humans; Infections; Lipids; Lipids - chemistry; Medical sciences; Mycoses - drug therapy; Nephrotoxicity; Pharmacology. Drug treatments; Reviews of Anti-Infective Agents; Treatment Outcome; Human; In vivo; Amphotericin B; Indication; Toxicity; Secondary effect; Pharmacokinetics; Case history; In vitro; Biological activity
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/376634

When introduced in 1959, amphotericin B deoxycholate (AmBD) was clearly a life-saving drug. Randomized studies demonstrating its efficacy were not thought to be necessary, and it was granted indications for many invasive fungal infections. Despite its formidable toxicities, AmBD is thus often used as the primary comparator in studies of invasive fungal infections. Safer lipid-based versions of amphotericin B (AmB) have been introduced, but difficulties with studying these agents generally led to licensure for salvage therapy, not primary therapy. However, the cumulative clinical experience to date with the lipid-based preparations is now adequate to demonstrate that these agents are no less active than AmBD, and, for some infections, it can now be stated that specific lipid-based preparations of AmB are superior to AmBD. Given their superior safety profiles, these preparations can now be considered suitable replacements for AmBD for primary therapy for many invasive fungal infections in clinical practice and research.