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.