Which formulation of amphotericin B is preferred for induction therapy in cryptococcal meningitis?

• A. Amphotericin B deoxycholate
• B. Amphotericin B lipid complex
• C. No amphotericin B
• D. Liposomal amphotericin B

Answer: (D)

Induction therapy for cryptococcal meningitis aims to rapidly reduce fungal burden in the CNS while keeping kidney toxicity low. The liposomal formulation of amphotericin B fits this goal best because it delivers high drug levels in the CNS with substantially reduced nephrotoxicity and fewer infusion-related reactions compared with the conventional amphotericin B deoxycholate. This tolerability allows the use of the recommended induction dosing that, when paired with flucytosine, achieves effective early sterilization of CSF. In contrast, amphotericin B deoxycholate causes more renal impairment and electrolyte disturbances, limiting how aggressively it can be used. The lipid complex formulation offers some toxicity reduction but does not match the liposomal form’s favorable safety profile, making liposomal amphotericin B the preferred choice for induction therapy in cryptococcal meningitis.