Antifungal agents. Part I. Amphotericin B preparations and flucytosine

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Published on: February 14, 2018

R Patel1

  • 1Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota, USA.

Mayo Clinic Proceedings
|December 30, 1998
PubMed

Insights

Amphotericin B is a key antifungal, but its toxicity limits use. Newer lipid formulations offer reduced kidney damage for treating deep fungal infections, with flucytosine useful for specific cases like cryptococcal meningitis.

Area of Science:

  • Mycology
  • Pharmacology
  • Infectious Diseases

Background:

  • Amphotericin B deoxycholate is a traditional antifungal but causes significant toxicity, limiting its use.
  • Deep-seated mycotic infections require effective treatment, historically relying on amphotericin B.
  • Emerging lipid formulations of amphotericin B aim to mitigate toxicity, particularly nephrotoxicity.

Purpose of the Study:

  • To review the pharmacologic properties of various amphotericin B formulations.
  • To summarize indications, dosages, costs, and adverse effects of amphotericin B preparations.
  • To discuss the role of flucytosine in specific fungal infections.

Main Methods:

  • Literature review of amphotericin B and flucytosine.
  • Comparative analysis of different amphotericin B formulations.
  • Summary of clinical guidelines and pharmacoeconomic data.

Main Results:

  • Lipid formulations (lipid complex, cholesteryl sulfate, liposomal) show reduced nephrotoxicity compared to deoxycholate.
  • Each formulation has distinct pharmacologic profiles, indications, and cost implications.
  • Flucytosine is effective for certain infections like cryptococcal meningitis but requires renal function monitoring.

Conclusions:

  • Lipid formulations of amphotericin B represent a safer alternative for treating invasive fungal infections.
  • Careful consideration of formulation, indication, and patient factors is crucial for optimal antifungal therapy.
  • Flucytosine remains a valuable adjunct, especially in CNS fungal infections, with appropriate precautions.

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