A Head-on Comparison of the In Vitro Antifungal Activity of Conventional and Lipid-based Amphotericin B: a Multicenter Study

Abstract

A comparative study of conventional amphotericin B, Abelcet and AmBisome was performed using a microdilution format of the NCCLS M27-A methodology for susceptibility testing against 300 fungal isolates (152 yeasts, 148 filamentous fungi) in both RPMI-1640 and antibiotic medium #3 (AB3). The clinical isolates included Candida albicans (n=54), Candida glabrata (n=25), Candida parapsilosis (n=23), Candida krusei (n=19), Candida lusi-taniae (n=14), Cryptococcus neoformans (n=5), Candida tropicalis (n=12), Aspergillus flavus (n=34), Aspergillus fumigatus (n=46) and 68 other filamentous fungi encompassing 22 different genera. The minimal inhibitory concentrations (MIC) for all drugs were defined as the lowest concentrations in which there was no visible growth. MICs were determined after 48 h for yeasts and 72 h for filamentous fungi. The mean MICs ± standard error (μg/ml) for yeasts and filamentous fungi, respectively, were: Abelcet, 0.51 ± 0.21, 4.34± 0.61; AmBisome, 1.28± 0.24, 5.68± 0.57; amphotericin B, 0.29± 0.11, 1.12± 0.19, respectively. Overall, against both yeasts and filamentous fungi Abelcet proved to have more potent antifungal activity than AmBisome. Using AB3 as opposed to RPMI-1640 generally produced lower MIC values but did not have any effect on the order of relative activity with all of the antifungal agents tested. In conclusion, our data shows that Abelcet is more active than AmBisome against pathogenic yeast and filamentous fungi when assayed in AB3 In Vitro. Comparison of the activities of these antifungals in experimental animal models is necessary to determine whether these In Vitro findings are correlated with in vivo efficacy.