In a neutropenic patient with suspected invasive fungal infection presenting with fever and left pleural effusion, the appropriate initial antifungal therapy is?

• A. Voriconazole
• B. Fluconazole
• C. Itraconazole
• D. Amphotericin B

Answer: (D)

In febrile, severely neutropenic patients with suspected invasive fungal infection, starting broad antifungal coverage promptly is crucial because these infections can progress rapidly and the immune response is blunted. Amphotericin B provides wide-spectrum fungicidal activity against many yeasts and molds, including Candida, Aspergillus, and Mucorales, making it a strong initial choice when the exact organism isn’t known yet. Other options have narrower or more limited coverage: fluconazole and itraconazole don’t reliably cover molds such as Aspergillus or mucorales; voriconazole covers Aspergillus well but not all molds (notably lacking activity against mucormycosis). Therefore, amphotericin B offers the best chance to control a potentially life-threatening invasive fungal infection in this high-risk setting. Liposomal amphotericin B can be used to reduce toxicity while preserving broad activity.