Clinical Uses

Amphotericin B is most commonly used to treat serious disseminated yeast and dimorphic fungal infections in immunocompromised hospitalized patients. As additional experience has been gained in the treatment of fungal infections with the newer azoles, the use of am-photericin B has diminished; if azole drugs have equivalent efficacy, they are preferred to amphotericin B because of their reduced toxicity profile and ease of administration. For the unstable neutropenic patient with Candida albicans fungemia, amphotericin B is the drug of choice. For the stable nonneutropenic patient with C. albicans fungemia, fluconazole appears to be an acceptable alternative. For the AIDS patient with moderate to severe cryptococcal meningitis, amphotericin B appears to be superior to fluconazole for initial treatment; once infection is controlled, fluconazole in a daily oral dose is superior to and more convenient than weekly intravenous amphotericin B in the prevention of clinical relapses. For the AIDS patient with disseminated histoplasmosis, the treatment is similar; ampho-tericin B is preferred for the initiation of treatment, but once infection is controlled, daily oral itraconazole is preferred to intermittently dosed amphotericin B for suppression of chronic infection. Most forms of blasto-mycosis and sporotrichosis in normal hosts no longer require amphotericin B treatment.

Amphotericin B remains the drug of choice in the treatment of invasive aspergillosis, locally invasive mu-cormycosis, and many disseminated fungal infections occurring in immunocompromised hosts (the patient population most at risk for serious fungal infections). For example, the febrile neutropenic oncology patient with persistent fever despite empirical antibacterial therapy is best treated with amphotericin B for possible Candida spp. sepsis.

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