The current role of amphotericin B lipid complex in managing systemic fungal infections

Background: An increase in the number of immunocompromised patients has led to a rising burden of systemic fungal infections. Historically, conventional amphotericin B has been used to treat these infections due to its broad spectrum of activity. The development of lipid-based amphotericin B agents, such as Abelcet* (ABLC), has allowed clinicians to take advantage of the broad spectrum of activity of amphotericin B while reducing adverse events. As well as this, a number of new antifungal agents have been developed in recent years which have significantly added to the treating physician's antifungal armamentarium. Objectives: Review the clinical data that support the use of ABLC and discuss the evidence for its continuing role in the treatment of invasive fungal infections in light of the introduction of newer antifungal agents. Methods: Published studies were identified by searching the MEDLINE database and the Cochrane Centre for Reviews up to August 2009. The search was conducted using the following key words: Amphotericin, Lipid, Abelcet, AmBisome, Efficacy, Nephrotoxicity, Renal, Toxicity. Findings: ABLC is effective and well-tolerated in the treatment of systemic fungal infections and remains a valuable therapeutic option in a variety of immunocompromised patients due to its broad antifungal spectrum and rarity of resistance. Limitations: Data from randomised controlled trials of lipid-based amphotericin B formulations, as well as head-to-head comparison studies between ABLC and other antifungal agents are limited. In addition, the review uses a narrative approach and relies to a great extent on the authors' personal views and experiences.