Fungal cells are eukaryotic, just like ours, so finding drugs that hit them without harming us is the real puzzle. Azoles block their ergosterol synthesis, echinocandins attack their cell wall, and amphotericin B just binds to that ergosterol and punches holes in them. The obvious answer is about cell structure, but in the ICU, the hardest part is watching amphotericin's chills and fever wreck my already critical patient while I wait for cultures. Every vial feels like a necessary betrayal.
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