Liposomal amphotericin B (AmBisome®) at beginning of its third decade of clinical use

Haematologists have been using liposomal amphotericin-B (L-AMB) since 1993 and despite the introduction of several novel antifungal agents over the past decade, their propensity to prescribe L-AMB remains unchanged. Although antifungal guidelines strongly recommend voriconazole as the drug of choice in the treatment of probable and proven invasive fungal disease (IFD), L-AMB is widely used in the real life because of its several advantages in terms of wide anti-mould spectrum, tolerability and efficacy. Furthermore, the concept that L-AMB is endowed with immune-modulating effects, which may have a role in fighting IFD, represent another reason for its use in patients who do not tolerate an excess of inflammation. Finally, given its tolerability and safety, L-AMB is an ideal partner for combining therapy, particularly with echinocandins with which shares the immunological properties that result in a synergistic effect.