The in vitro antifungal activities of amphotericin B (AMB) and amphotericin B methyl ester (AME) were compared against 465 clinical isolates of Candida albicans. AMB and AME possessed comparable activity against half of the strains, but against the remainder of the strains the activity of AME was slightly lower than that of AMB. Rarely did AME show superior antifungal activity to AMB.Amphotericin B (AMB) is the most effective antibiotic currently available for the treatment of serious fungal infections in humans. Its usefulness is hampered by its nephrotoxicity and other side effects (4,7,10,11). Amphotericin B methyl ester (AME), the water-soluble derivative of AMB, has been shown in experimental animals to be significantly less toxic than the parent compound (6) and to be effective in the treatment of certain experimental fungal infections (1,8). Although systemic candidiasis is likely to be a major indication for AME therapy once approved for human use, there is little published information on the in vitro susceptibility of Candida albicans to this antibiotic (2, 5, 9). We report the comparative susceptibility of 465 clinical isolates of C. albicans to AMB and AME.MATERIALS AND METHODS Cultures. Four hundred and sixty-five C. albicans isolates, each from a different patient, were obtained from a variety of clinical sources. Duplicate or triplicate isolates of49 of these strains were available and tested. All isolates were identified by germ tube production, sugar fermentation pattern, and carbohydrate assimilation tests with sucrose. Isolates were maintained on nutrient agar slants at 22°C. Before testing, strains were grown on 5% horse blood agar plates for 20 to 40 h at 37°C. Cells were harvested with sterile normal saline, and the turbidity of the suspension was adjusted to a standard transmission of 90% at 530 nm on a Spectronic 20 spectrophotometer (Bausch and Lomb).Media. The susceptibility tests were performed in a solid synthetic medium (5). The medium was dispensed in 350-ml quantities into 1-liter Erlenmeyer flasks and sterilized by autoclaving. AMB or AME was added to the melted agar, mixed well, and dispensed into sterile square petri dishes (100 by 15 mm, integrid; Falcon Plastics). Plates were cooled, stored at 4°C in the dark, and used within 48 h.Preparation of antibiotic dilutions. A 5.0-mg amounit of AMB or AME (E. R. Squibb and Sons, Inc.) was dissolved in 5 ml of sterile dimethyl sulfoxide and diluted with sterile distilled water to obtain stock solutions containing from 200 to 6.25 ,ug/ml. A 3.5-ml portion of the latter or sterile distilled water was added to each flask containing 350 ml of molten agar to produce final concentrations of AMB or AME of 0, 0.0625, 0.125, 0.25, 0.5, 1.0, and 2.0 ug/ml of medium. Susceptibility testing. Standardized cell suspensions of C. albicans were inoculated onto the agar plates by using a Steers replicator. Plates were incubated at 37°C in the dark and read after 48 and 72 h. Complete absence of growth in at least two of three test cultures was considere...