Amphotericin B use in a major acute care hospital

A retrospective study was undertaken to assess the use of the antifungal agent amphotericin B in a major acute care hospital. Data were reviewed from 82 patients who were prescribed amphotericin B at Vancouver General Hospital between March 1 and September 1, 1990. Sixty-one percent of the patients treated with amphotericin B were from the hematology service, 22% were from the intensive care unit (ICU) service, and the remainder were from other hospital services. Fever of unknown origin was the most common reason for amphotericin B use in the hematology patients, while candidemia was most prevalent in the ICU patients. Renal dysfunction during treatment was common and related to the dose received. Test doses were used in the majority of courses, and premedications were also common. Cumulative doses administered were typically lower than intended. Amphotericin B treatment was considered successful in 46% of the cases reviewed. This review provides insight into how amphotericin B is used at one hospital and how this use may be improved. Potential applications for fluconazole are also discussed.