Amphotericin B in the Era of New Antifungals: Where Will It Stand?

Author:

Akinosoglou Karolina12ORCID,Rigopoulos Emmanouil Angelos1,Papageorgiou Despoina1,Schinas Georgios1ORCID,Polyzou Eleni1,Dimopoulou Effrosyni3,Gogos Charalambos1,Dimopoulos George4

Affiliation:

1. School of Medicine, University of Patras, 26504 Patras, Greece

2. Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece

3. Hellenic Institute for the Study of Sepsis, 11528 Athens, Greece

4. 3rd Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece

Abstract

Amphotericin B (AmB) has long stood as a cornerstone in the treatment of invasive fungal infections (IFIs), especially among immunocompromised patients. However, the landscape of antifungal therapy is evolving. New antifungal agents, boasting novel mechanisms of action and better safety profiles, are entering the scene, presenting alternatives to AmB’s traditional dominance. This shift, prompted by an increase in the incidence of IFIs, the growing demographic of immunocompromised individuals, and changing patterns of fungal resistance, underscores the continuous need for effective treatments. Despite these challenges, AmB’s broad efficacy and low resistance rates maintain its essential status in antifungal therapy. Innovations in AmB formulations, such as lipid complexes and liposomal delivery systems, have significantly mitigated its notorious nephrotoxicity and infusion-related reactions, thereby enhancing its clinical utility. Moreover, AmB’s efficacy in treating severe and rare fungal infections and its pivotal role as prophylaxis in high-risk settings highlight its value and ongoing relevance. This review examines AmB’s standing amidst the ever-changing antifungal landscape, focusing on its enduring significance in current clinical practice and exploring its potential future therapeutic adaptations.

Publisher

MDPI AG

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