[The use of amphotericin B in a general hospital]

Amphotericin B (AmB) remains the standard treatment for most systemic mycosis. In addition to the ordinary deoxycholate formulation (AmB-DC), liposomal AmB (AmB-LP) is available in the United Kingdom. The aim of this study was to determine the patterns of usage of AmB in the present situation.

A 3 month prospective audit (August-October 1992) and a 3 year retrospective analysis of usage and expenditure in a United Kingdom University Hospital were carried out.

A total of 42 courses and 564 days of treatment with AmB were analysed during the prospective audit. The total cost of AmB was 38,000 pounds (roughly 7,600,000 pesetas). AmB-LP accounted for 92% of the expenditure 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 treatment. Only 65% of the days of treatment with AmB-LP were used according to the institution guidelines. The estimated cost of the days of treatment with AmB-LP that did not follow the institution guidelines was 9,500 pounds (roughly 1,800,000 pesetas). The retrospective analysis revealed a striking increase in the expenditure on AmB since the release of AmB-LP. There was an steady growth in the usage of both AmB-DC and AmB-LP over the 3 year period analysed.

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 prescriptions habits of AmB-LP could be improved. To ensure an appropriate usage a direct control of AmB-LP might be advisable.