Antifungals and renal safety - getting the balance right

Many patients who receive antifungal agents are immunocompromised or critically ill. This leaves many of these patients prone to renal failure, especially following transplantation. A wealth of clinical data have shown that older antifungal agents, particularly conventional amphotericin B deoxycholate (AmBd), are still highly efficacious, except that AmBd confers extensive nephrotoxicity. This paper examines the pharmacological alternatives that could provide a more suitable balance between clinical efficacy and renal safety. (c) 2006 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.