THE USE OF AMPHOTERICIN-B IN A GENERAL-HO SPITAL

BACKGROUND: Amphotericin B (AmB) remains the standard treatment for mo st systemic mycosis. In addition to the ordinary deoxycholate formulat ion (AmB-DC), liposomal AmB (AmB LP) is available in the United Kingdo m. The aim of this study was to determine the patterns of usage of AmB in the present situation. METHODS: A 3 month prospective audit (Augus t-October 1992) and a 3 year retrospective analysis of usage and expen diture in a United Kingdom University Hospital were carried out. RESUL TS: A total of 42 courses and 564 days of treatment with AmB were anal ysed during the prospective audit. The total cost of AmB was 38.000 po unds (roughly 7.600.000 pesetas). AmB-LP accounted for 92% of the expe nditure on AmB and 72% of the total expenditure on antifungals during the survey period. In 60% of the courses AmB was given as an empiric t reatment Only 65% of the days of treatment with AmB-LP were used accor ding to the institution guidelines. The estimated cost of the days of treatment with AmB-LP that did not follow the institution guidelines w as 9.500 pounds (roughly 1.800.000 pesetas). The retrospective analysi s revealed a striking increase in the expenditure on AmB since the rel ease of AmB-LP. There was an steady growth In the usage of both AmB-DC and AmB-LP over the 3 year period analysed. CONCLUSIONS: AmB is being increasingly used, mainly as an empiric treatment. The release of AmB -LP has had a great impact on the AmB budget. The current prescription s habits of AmB-LP could be improved. To ensure an appropriate usage a direct control of AmB-LP might be advisable.