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 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.
Ostrosky-Zeichner
Luis
L
Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, TX, USA. Luis.Ostrosky-Zeichner@uth.tmc.edu
Marr
Kieren A
KA
Rex
John H
JH
Cohen
Stuart H
SH
D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D002986:Clinical Trials as Topic; D004337:Drug Carriers; D016503:Drug Delivery Systems; D006801:Humans; D008055:Lipids / Q000737:chemistry; D009181:Mycoses / Q000188:drug therapy*; D016896:Treatment Outcome
D000935:Antifungal Agents; D004337:Drug Carriers; D008055:Lipids; D000666:Amphotericin B