Editorial Response: Approaches to Therapy for Invasive Mycoses—The Role of

Amphotericin B remains the standard therapy for many inva- While the experience with use of amphotericin B was very sive mycoses. Advantages associated with amphotericin B in- favorable in this retrospective review, several factors responsi-clude a broad spectrum of activity, a rapid onset of action, and ble for the high rate of efficacy and reduced rate of renal or intravenous mode of administration [1]. Nevertheless, the toxic infusional toxicity should be noted. First, the doses of ampho-effects associated with amphotericin B are well known and tericin B used were not very high: the total dose administered significant, including infusion-related adverse events and dose- ranged from 10 mg to 840 mg, but the mean dose was limiting nephrotoxicity [1, 2]. A number of measures have been 200 mg. Daily dosages of amphotericin B were not recorded. commonly used to limit both infusional and renal toxic effects However, the authors noted a clear association between total associated with amphotericin B, including premedication with doses administered and renal toxicity. antipyretics, antihistamines, corticosteroids, and merperidine Second, the types of fungal infection requiring therapy and [1]. The need for premedication and the utility of such drugs, the risk factors of the patients receiving therapy may have also alone or in combination, have been questioned. In addition, the contributed to a favorable outcome. In this setting, the vast efficacy of amphotericin B in some mycoses is limited, which majority of the infections were fungemia, funguria, or empirical may be owing in part to use of inadequate doses of drug as diagnoses. Few mold infections were suspected, and most doc-well as other host and organism factors [3, 4]. umented infections were due to Candida albicans, condition