What is the initial treatment for severe fungal infections like histoplasmosis?

The initial treatment for severe fungal infections such as histoplasmosis is liposomal amphotericin B. This formulation is preferred due to its improved safety profile and reduced nephrotoxicity compared to traditional amphotericin B, especially in patients who may require higher doses or prolonged therapy. Liposomal amphotericin B effectively penetrates the tissues and targets systemic infections, making it suitable for severe presentations of histoplasmosis where the invasive form of the fungus can lead to serious complications.

In considering other options, traditional amphotericin B could be considered, but it carries a higher risk of side effects, particularly renal impairment, which is a crucial consideration in intensive treatment scenarios. Fluconazole, while effective for certain fungal infections, is generally used for less severe cases or for maintenance therapy rather than as an initial treatment for severe infections. Doxycycline is an antibiotic with no efficacy against fungal pathogens and would not be indicated in this context. Therefore, liposomal amphotericin B stands out as the optimal choice for initial management of severe histoplasmosis.