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Amphotericin B: Polyene Resistance Mechanisms

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Antimicrobial Drug Resistance

Part of the book series: Infectious Disease ((ID))

Resistance to amphotericin B is still rare. Resistance has become more evident recently, because of the increase in the rate of non-albicans Candida species and emerging invasive mould infections that have intrinsic or acquired resistance to azoles and polyenes. Non-albicans candidemia now accounts for 30-60% of all candidemias (2, 3). Resistance can be categorized into three main categories: primary or intrinsic, acquired, and clinical resistance. Intrinsic or primary resistance occurs without exposure to anti-fungals. Acquired or secondary resistance develops during treatment, and often occurs as a result of one or several genetic mutations (4). Intrinsic resistance to amphotericin B is rare among pathogenic fungi infecting humans, and acquired resistance during therapy is even less common (5, 6). Although polyene resistance has not been a major clinical problem to date, polyene-resistant yeasts and moulds continue to be reported (9). Identifi cation of a particular yeast or mould to the species level helps to predict possible polyene resistance, and can be extremely important to help guide the choice of antifungal therapy. Clinical resistance, i.e., failure of anti-fungal therapy, is multifactorial, and depends on a variety of factors, such as the immune status of the host, pharmacokinetics of the antifungal agent, and the species of infecting fungus. In many instances, resistance to amphotericin B may not be related to the minimum inhibitory concentration (MIC), but to failure of the antifungal agent to penetrate into infected tissue (7).

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Authors and Affiliations

  1. Research Fellow, Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA

    Elizabeth M. O'Shaughnessy

  2. Research Scientist, Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA

    Caron A. Lyman

  3. Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA

    Thomas J. Walsh

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  3. Thomas J. Walsh
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  1. Executive Vice President & Chief Medical Offi cer, Idenix Pharmaceuticals, Cambridge, MA, USA

    Douglas L. Mayers MD

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© 2009 Humana Press, a part of Springer Science+Business Media, LLC

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O'Shaughnessy, E.M., Lyman, C.A., Walsh, T.J. (2009). Amphotericin B: Polyene Resistance Mechanisms. In: Mayers, D.L. (eds) Antimicrobial Drug Resistance. Infectious Disease. Humana Press. https://doi.org/10.1007/978-1-59745-180-2_25

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  • DOI: https://doi.org/10.1007/978-1-59745-180-2_25

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60327-592-7

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