ABSTRACT

Polyene antifungals, notably amphotericin B, have been mainstays for the prevention and treatment of invasive fungal infections (IFIs) for over six decades. Amphotericin B possesses a broad-spectrum of antifungal activity in vitro against a variety of yeasts and molds, including Candida spp. (with the exception of C. lusitaniae), endemic mycoses, Aspergillus spp., and pathogens responsible for mucormycosis. Adverse effects associated with amphotericin B include significant electrolyte abnormalities (notably hypokalemia), infusion-related reactions (fever, rigors) and nephrotoxicity. While more expensive, lipid-based formulations have largely replaced amphotericin B deoxycholate to reduce the risk of nephrotoxicity. Because of its dependency on intravenous administration and poor tolerability, amphotericin B is used as primary antifungal therapy for only a select group of invasive infection (including CNS infections, zygomycoses, and disseminated cryptococcal infections) and for invasive, refractory cases of aspergillosis, candidiasis, and endemic mycoses.