Editorial Response: Choosing Amphotericin B Formulations--Between a Rock and a Hard Place

Abstract

When choosing lipid formulations of amphotericin B to be used in treatment, physicians and pharmacies have been forced to choose on the basis of either price and or adverse reactions. There have been no adequate studies comparing the efficacy of any 2 amphotericin B formulations in proven cases of mycosis; all comparisons performed so far have been either with historical controls of limited value or with empirical therapy. Although amphotericin B has come to be used in febrile neutropenic patients who have not responded to as little as 72 h of antibacterial therapy, there are no studies that have established the efficacy of antifungal therapy at this juncture, with or without prior fluconazole prophylaxis. Without knowing whether amphotericin B is needed at all, concluding that 2 formulations are equally efficacious is meaningless.