Fungal infections have emerged as an increasingly serious public health challenge globally. Four Formulations of amphotericin B are widely used in antifungal therapy. Despite the same active ingredient, they probably differ in efficacy, safety and economics.

This study aimed to explore the differences in efficacy, safety and economy among different formulations of amphotericin B in patients with IFD.

We conducted a retrospective study at a tertiary hospital, examining patients who were administered amphotericin B from June 2023 to March 2025, to assess the efficacy, safety and economy of different amphotericin B Formulations in invasive fungal disease.

(1) A total of 71 patients were included. Patients with potential renal injury are more likely to choose liposomal amphotericin B (p = 0.021). (2) Liposomal amphotericin has the accelerated therapeutic onset (p = 0.042), amphotericin B deoxycholate has the delayed therapeutic effect (p = 0.031), the effective response of liposomal amphotericin B in elders was significantly lower (p = 0.022), and the counterpart of amphotericin B deoxycholate in females was significantly higher (p = 0.01). (3) The main adverse events of the three amphotericin B formulations were kidney injury (p < 0.001), there was no significant inter-group difference. (4) The amphotericin B deoxycholate group incurred the most economical total cost (p < 0.01), daily cost (p < 0.01) and cost-effectiveness.

Amphotericin B formulations exhibit marked variations in efficacy and economy profiles, necessitating individualized selection guided by specific clinical characteristics. Rigorous monitoring of renal function remains imperative throughout the therapeutic course.