Amphotericin-B

Amphotericin B (AmB), a polyene antifungal, was first isolated from Streptomyces nodosus in 1955. This broad-spectrum, potent antimycotic agent with a favorable resistance profile has been widely used ever since. Several formulations have been developed, the first being the conventional deoxycholate (D-AmB). Because of the significant toxicity associated with it, the liposomal amphotericin B (L-AmB) and the amphotericin B lipid complex (ABLC) saw the light in the 1990s. Amphotericin B colloidal dispersion (ABCD) is a fourth formulation that is no longer manufactured in the United States. The different formulations of AmB are not interchangeable, as they differ in terms of size, serum concentration, pharmacokinetic and pharmacodynamic properties, dose, and toxicity profiles. Despite the new and possibly safer options for antifungal treatment, L-AmB remains the first-line therapy for several fungal infections. Its use has been mostly based on case series and case reports rather than randomized trials. It is desirable to conduct rigorous trials for better identification of optimal dosing of specific formulations of Amphotericin B, especially in indications associated with high mortality and/or those with rare occurrence. It is also needed to better evaluate the efficacy and safety of AmB as compared to newer antifungal agents recently released or under development.