A high-performance liquid chromatographic method for the determination of amphotericin B concentrations in human serum without bilirubin interference was developed and compared with a microbiological assay. The high-performance liquid chromatographic assay utilized a reversed-phase trimethyl silica column, simple sample preparation, and visible detection. Reproducibility studies yielded coefficient-of-variation ranges from 1.02 to 2.11% for within-day precision and 2.88 to 4.32% for between-day precision. The correlation coefficient with the microbiological assay was 0.984 for amphotericin B.Amphotericin B (AMB) is a polyene antifungal agent which was isolated from Streptomyces nodosus in 1956 (10) and remains today the drug of choice for the treatment of systemic fungal infections (5, 12). The most frequent and clinically significant side effect of AMB therapy is nephrotoxicity (8). Although toxicity is generally dose dependent, there is considerable interindividual variability among patients. Because of these large individual variations in AMB levels in serum with oral administration, a method is required for frequent and rapid estimation of drug levels which provide adequate antifungal activity but do not produce adverse effects.The concentrations of AMB in serum were previously determined by microbiological assays (2, 11). Although bioassays have been used traditionally for the determination of concentrations of antibiotics, they have limited sensitivity and reproducibility. The additional disadvantages of bioassays are their lack of specificity and the length of time required for sample analysis. High-performance liquid chromatography (HPLC) provides a sensitive and specific alternative to bioassays, with the additional advantages of high precision and rapid turnaround time. We developed a sensitive HPLC assay for the measurement of AMB in serum and compared it with the microbiological assay.The HPLC assay was performed with an LC-6A pump, an SPD-6AV UV-visible variable-wavelength detector, and a C-R4A computing integrator (Shimadzu, Kyoto, Japan). Analysis was performed on a reversed-phase CLC-trimethylsilyl column (5 ,um; 150-by 6.0-mm [inside diameter]; Shimadzu). Samples were injected with a Rheodyne syringeloading sample injector (model 7125; Shimadzu) fitted with a 50-,ul loop. The mobile phase for HPLC analysis consisted of an acetonitrile-10 mM acetate buffer (pH 7.4) mixture (40/60, vol/vol). The mobile phase was degassed and delivered with a flow of 1.0 ml/min at room temperature. The A405 of the column effluent was monitored (0.005 absorbance units full scale).Serum samples used in this study were obtained from patients with systemic fungal infections receiving AMB as well as other antibiotics for which various determinations of * Corresponding author. concentrations in serum had been ordered as part of the clinical management of the patients. Serum standards and controls were prepared by dissolving AMB (Japan Squibb, Tokyo, Japan) in dimethyl sulfoxide and diluting the solution in drug-free pool...