Retrospective review of amphotericin B use in a tertiary-care medical center.
A retrospective review of amphotericin B use in a tertiary-care medical center was conducted, and use patterns were evaluated. The pharmacy department audited the medical records of all patients who received amphotericin B during 1983. Of 179 patients who received amphotericin B, the medical records of 140 patients were suitable for review. Amphotericin B use increased almost tenfold over a six-year period. Medical services used approximately two thirds of the total drug, while surgery used one fourth. Amphotericin B was used systemically in 98 patients and as a bladder irrigant in 42 patients. In a third of cases, the drug was used when a fungal infection was not documented. Daily dosages of less than 25 mg and total dosages of 500 mg were commonly administered. Amphotericin B was frequently administered with other antimicrobial agents in patients with serious underlying diseases; therefore, evaluation of its efficacy in all patients was difficult. Clinical nephrotoxicity was detected during treatment in approximately 15% of patients. Amphotericin B is no longer used exclusively for classical deep-seated mycoses; frequently, the drug is used as empiric treatment for candida and aspergillus infections. Amphotericin B use has risen because of the difficulty in diagnosing deep-seated mycoses and because of the frequent isolation of yeasts from seriously ill patients. Prospective studies are needed to guide clinicians in determining indications for amphotericin B use and the proper dosage and length of treatment for the drug.
Gross, MH; Pickard, WW; Perfect, JR
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