fluconazole + liposomal amphotericin b

Fluconazole + liposomal amphotericin B is a combination antifungal therapy used primarily for the treatment of severe systemic fungal infections, including cryptococcal meningitis and other invasive mycoses. Fluconazole is a triazole antifungal that inhibits the fungal cytochrome P450 enzyme 14α-demethylase, thereby blocking ergosterol synthesis and disrupting cell membrane formation. Liposomal amphotericin B is a polyene antifungal encapsulated in liposomes to reduce toxicity; it binds to ergosterol in fungal cell membranes, creating pores that lead to cell death. The combination aims to leverage the broad-spectrum activity of amphotericin B with the oral availability and CNS penetration of fluconazole. However, their interaction can be concentration-dependent—at higher concentrations of fluconazole, antagonism may occur due to reduced ergosterol content impairing amphotericin B’s action. This regimen is especially relevant for immunocompromised patients (e.g., those with HIV/AIDS) facing life-threatening mycoses.