GARY WILSON, M.D.; JAMES E. PEACOCK JR., M.D.
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To the editor: The case of amphotericin-B-resistant Candida guilliermondii described by Dick and colleagues (1) certainly epitomizes the growing problem of fungal disease and its therapy in the immunocompromised patient. However, the report also left several questions unanswered.
One question relates to the effect of prior imidazole exposure on fungal sensitivity to amphotericin B. The antifungal activity of amphotericin B is mediated through binding of the drug to ergosterol within fungal cell walls (2). In contrast, imidazoles inhibit ergosterol synthesis. Thus, exposure to imidazoles may result in the development of progressive resistance to amphotericin B because of decreasing ergosterol content
WILSON G, PEACOCK JE. Imidazoles, Ketoconazole, Amphotericin B, and Candida guilliermondii. Ann Intern Med. ;102:866. doi: 10.7326/0003-4819-102-6-866_1
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Published: Ann Intern Med. 1985;102(6):866.
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