Fungal infections have increased in morbidity, and the range of fungal species causing disease in humans has expanded, mainly due to the rise in number of immunocompromised patients. Amphotericin B is a broad spectrum antifungal agent that has been the standard therapy for many life-threatening mycoses for the past 50 years. However, the use of this drug is commonly associated with infusion related events (such as chills, fever, headache, nausea, vomiting), and most significantly to dose limiting nephrotoxicity. Three lipid formulations that increase the therapeutic index have been approved for use. However, questions regarding dose, cost-effectiveness and indications exist in the pediatric setting. Although no high quality evidence studies in children comparing the four types of amphotericin in culture-positive fungal infections currently exist, all four preparations are believed to have similar effectiveness. High drug costs limit the use of lipid formulations; however, renal toxic side effects should be taken into account when costs are considered.
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