Amphotericin B (Ophthalmic — Severe Fungal Keratitis/Endophthalmitis)

How it works

It binds ergosterol in the fungal cell membrane, forming pores that disrupt membrane integrity and cause fungal cell death.

Prescribing in practice

• It is a specialist, unlicensed ophthalmic preparation prepared and administered under expert supervision, with intravitreal dosing demanding meticulous accuracy because the drug is retinotoxic in excess.
• It is used for severe fungal eye infections, often Candida or filamentous fungi, with choice and route guided by microbiology and the depth of infection.
• Topical use can cause ocular surface irritation, and the preparation must be protected from light and used promptly.

Monitoring

Monitor the clinical and microbiological response of the infection and assess retinal status when intravitreal administration is used.

Counselling the patient

• This is a specialist treatment for a serious fungal infection of the eye, given under close supervision.
• Attend all review appointments so the response to treatment can be checked.
• Report increasing pain, redness or worsening vision between visits.

Evidence & guidelines

Topical and intravitreal amphotericin B is a standard specialist option for fungal keratitis and endophthalmitis, used as an unlicensed preparation under expert guidance.