Amphotericin B

Stanley W. Chapman, John D. Cleary, Phillip Rogers

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Amphotericin B (AmB) has been the cornerstone of antifungal therapy for almost 50 years. Discovered in the late 1950s, it was approved for human use as an antifungal agent in 1960. Initial formulations of AmB were plagued with impurities. Allergic responses, presumably secondary to these impurities, and endotoxin-like infusion-related reactions were common. Although improvements in purification and fermentation over the last 30 years have enhanced tolerability, infusion-related reactions and renal dysfunction are still commonplace with the use of the deoxycholate solubilized formulation. Formulations using a lipid carrier have significantly improved tolerability. Safety aside, AmB remains the most effective, broad-spectrum, fungicidal agent with the greatest experience for the treatment of systemic mycoses. Both intrinsic and acquired resistance are limited. The treatment failures seen with AmB are multifaceted. These can be attributed to delays in diagnosis of invasive mycoses, the immune compromised state of the patient being treated, the unique pharmacokinetic/pharmacodynamic properties of the different formulations, and dose limitations related to toxicity. In an effort to enhance antifungal efficacy and reduce toxicity, AmB has been combined with other antifungals and new nonlipid formulations are being evaluated.

Original languageEnglish (US)
Title of host publicationEssentials of Clinical Mycology
Subtitle of host publicationSecond Edition
PublisherSpringer New York
Pages41-55
Number of pages15
ISBN (Electronic)9781441966407
ISBN (Print)9781441966391
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

Fingerprint

Amphotericin B
Deoxycholic Acid
Mycoses
Antifungal Agents
Treatment Failure
Endotoxins
Fermentation
Pharmacokinetics
Kidney
Lipids
Safety
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Immunology and Microbiology(all)

Cite this

Chapman, S. W., Cleary, J. D., & Rogers, P. (2011). Amphotericin B. In Essentials of Clinical Mycology: Second Edition (pp. 41-55). Springer New York. https://doi.org/10.1007/978-1-4419-6640-7_3

Amphotericin B. / Chapman, Stanley W.; Cleary, John D.; Rogers, Phillip.

Essentials of Clinical Mycology: Second Edition. Springer New York, 2011. p. 41-55.

Research output: Chapter in Book/Report/Conference proceedingChapter

Chapman, SW, Cleary, JD & Rogers, P 2011, Amphotericin B. in Essentials of Clinical Mycology: Second Edition. Springer New York, pp. 41-55. https://doi.org/10.1007/978-1-4419-6640-7_3
Chapman SW, Cleary JD, Rogers P. Amphotericin B. In Essentials of Clinical Mycology: Second Edition. Springer New York. 2011. p. 41-55 https://doi.org/10.1007/978-1-4419-6640-7_3
Chapman, Stanley W. ; Cleary, John D. ; Rogers, Phillip. / Amphotericin B. Essentials of Clinical Mycology: Second Edition. Springer New York, 2011. pp. 41-55
@inbook{fb1e4a33b1ec4e118bf35c35a19fbb2e,
title = "Amphotericin B",
abstract = "Amphotericin B (AmB) has been the cornerstone of antifungal therapy for almost 50 years. Discovered in the late 1950s, it was approved for human use as an antifungal agent in 1960. Initial formulations of AmB were plagued with impurities. Allergic responses, presumably secondary to these impurities, and endotoxin-like infusion-related reactions were common. Although improvements in purification and fermentation over the last 30 years have enhanced tolerability, infusion-related reactions and renal dysfunction are still commonplace with the use of the deoxycholate solubilized formulation. Formulations using a lipid carrier have significantly improved tolerability. Safety aside, AmB remains the most effective, broad-spectrum, fungicidal agent with the greatest experience for the treatment of systemic mycoses. Both intrinsic and acquired resistance are limited. The treatment failures seen with AmB are multifaceted. These can be attributed to delays in diagnosis of invasive mycoses, the immune compromised state of the patient being treated, the unique pharmacokinetic/pharmacodynamic properties of the different formulations, and dose limitations related to toxicity. In an effort to enhance antifungal efficacy and reduce toxicity, AmB has been combined with other antifungals and new nonlipid formulations are being evaluated.",
author = "Chapman, {Stanley W.} and Cleary, {John D.} and Phillip Rogers",
year = "2011",
month = "1",
day = "1",
doi = "10.1007/978-1-4419-6640-7_3",
language = "English (US)",
isbn = "9781441966391",
pages = "41--55",
booktitle = "Essentials of Clinical Mycology",
publisher = "Springer New York",
address = "United States",

}

TY - CHAP

T1 - Amphotericin B

AU - Chapman, Stanley W.

AU - Cleary, John D.

AU - Rogers, Phillip

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Amphotericin B (AmB) has been the cornerstone of antifungal therapy for almost 50 years. Discovered in the late 1950s, it was approved for human use as an antifungal agent in 1960. Initial formulations of AmB were plagued with impurities. Allergic responses, presumably secondary to these impurities, and endotoxin-like infusion-related reactions were common. Although improvements in purification and fermentation over the last 30 years have enhanced tolerability, infusion-related reactions and renal dysfunction are still commonplace with the use of the deoxycholate solubilized formulation. Formulations using a lipid carrier have significantly improved tolerability. Safety aside, AmB remains the most effective, broad-spectrum, fungicidal agent with the greatest experience for the treatment of systemic mycoses. Both intrinsic and acquired resistance are limited. The treatment failures seen with AmB are multifaceted. These can be attributed to delays in diagnosis of invasive mycoses, the immune compromised state of the patient being treated, the unique pharmacokinetic/pharmacodynamic properties of the different formulations, and dose limitations related to toxicity. In an effort to enhance antifungal efficacy and reduce toxicity, AmB has been combined with other antifungals and new nonlipid formulations are being evaluated.

AB - Amphotericin B (AmB) has been the cornerstone of antifungal therapy for almost 50 years. Discovered in the late 1950s, it was approved for human use as an antifungal agent in 1960. Initial formulations of AmB were plagued with impurities. Allergic responses, presumably secondary to these impurities, and endotoxin-like infusion-related reactions were common. Although improvements in purification and fermentation over the last 30 years have enhanced tolerability, infusion-related reactions and renal dysfunction are still commonplace with the use of the deoxycholate solubilized formulation. Formulations using a lipid carrier have significantly improved tolerability. Safety aside, AmB remains the most effective, broad-spectrum, fungicidal agent with the greatest experience for the treatment of systemic mycoses. Both intrinsic and acquired resistance are limited. The treatment failures seen with AmB are multifaceted. These can be attributed to delays in diagnosis of invasive mycoses, the immune compromised state of the patient being treated, the unique pharmacokinetic/pharmacodynamic properties of the different formulations, and dose limitations related to toxicity. In an effort to enhance antifungal efficacy and reduce toxicity, AmB has been combined with other antifungals and new nonlipid formulations are being evaluated.

UR - http://www.scopus.com/inward/record.url?scp=84920419674&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920419674&partnerID=8YFLogxK

U2 - 10.1007/978-1-4419-6640-7_3

DO - 10.1007/978-1-4419-6640-7_3

M3 - Chapter

SN - 9781441966391

SP - 41

EP - 55

BT - Essentials of Clinical Mycology

PB - Springer New York

ER -