Amphotericin B: Time for a New “Gold Standard”

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 a...

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Bibliographic Details
Published in:Clinical infectious diseases 2003-08, Vol.37 (3), p.415-425
Main Authors: Saravolatz, Louis D., Ostrosky-Zeichner, Luis, Marr, Kieren A., Rex, John H., Cohen, Stuart H.
Format: Article
Language:English
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
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Summary: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.
ISSN:1058-4838
1537-6591
DOI:10.1086/376634