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Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia.

Publication ,  Journal Article
Shehab, N; DePestel, DD; Mackler, ER; Collins, CD; Welch, K; Erba, HP
Published in: Pharmacotherapy
July 2007

STUDY OBJECTIVE: To assess the effectiveness, safety, and cost of empiric treatment of febrile neutropenia before and after implementing an algorithm in which voriconazole was substituted for liposomal amphotericin B (L-AmB). DESIGN: Retrospective cohort analysis. SETTING: An 850-bed tertiary care hospital, which is also a referral site for patients with acute leukemia. PATIENTS: Fifty-five adult patients who started empiric antifungal therapy for febrile neutropenia between January 1, 2002, and December 31, 2003, encompassing 58 treatment episodes (defined as a hospitalization during which empiric antifungal therapy was administered). MEASUREMENTS AND MAIN RESULTS: Medical charts, including patients' pharmacy and laboratory data, were reviewed. Twenty-six and 32 episodes of L-AmB and voriconazole use, respectively, were identified. No significant differences between the L-AmB and voriconazole groups were noted at baseline. Rates of fever resolution (54% vs 59%, p=0.791) and breakthrough invasive fungal infections (11% vs 12%, p>0.999) were similar for the L-AmB and voriconazole episodes. Premature drug discontinuation due to the prescriber's perceived lack of efficacy occurred most frequently in the voriconazole group (25% vs 8%, p=0.160). Survival was significantly higher in the voriconazole than in the L-AmB group (100% vs 77%, p=0.006). Adverse effects that were significantly more common in the L-AmB group than in the voriconazole group were elevated serum creatinine levels (27% vs 3%, p=0.017) and electrolyte disturbances (19% vs 0%, p=0.014). Adverse effects reported more frequently in the voriconazole group than in the L-AmB group were visual disturbances (9% vs 0%, p=0.245) and elevated hepatic enzyme levels (9% vs 8%, p>0.999). Mean drug expenditures/episode for initial empiric antifungal therapy were lower for voriconazole than for L-AmB ($1593 vs $4144, or $153 vs $380/day). CONCLUSION: Our institution's algorithm incorporating voriconazole into the empiric management of febrile neutropenia was associated with effectiveness outcomes comparable to those observed with L-AmB as well as a lower frequency of adverse effects and overall expenditures for antifungal drugs.

Duke Scholars

Published In

Pharmacotherapy

DOI

ISSN

0277-0008

Publication Date

July 2007

Volume

27

Issue

7

Start / End Page

970 / 979

Location

United States

Related Subject Headings

  • Voriconazole
  • Triazoles
  • Treatment Outcome
  • Pyrimidines
  • Pharmacology & Pharmacy
  • Neutropenia
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
 

Citation

APA
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ICMJE
MLA
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Shehab, N., DePestel, D. D., Mackler, E. R., Collins, C. D., Welch, K., & Erba, H. P. (2007). Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia. Pharmacotherapy, 27(7), 970–979. https://doi.org/10.1592/phco.27.7.970
Shehab, Nadine, Daryl D. DePestel, Emily R. Mackler, Curtis D. Collins, Kathleen Welch, and Harry P. Erba. “Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia.Pharmacotherapy 27, no. 7 (July 2007): 970–79. https://doi.org/10.1592/phco.27.7.970.
Shehab N, DePestel DD, Mackler ER, Collins CD, Welch K, Erba HP. Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia. Pharmacotherapy. 2007 Jul;27(7):970–9.
Shehab, Nadine, et al. “Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia.Pharmacotherapy, vol. 27, no. 7, July 2007, pp. 970–79. Pubmed, doi:10.1592/phco.27.7.970.
Shehab N, DePestel DD, Mackler ER, Collins CD, Welch K, Erba HP. Institutional experience with voriconazole compared with liposomal amphotericin B as empiric therapy for febrile neutropenia. Pharmacotherapy. 2007 Jul;27(7):970–979.

Published In

Pharmacotherapy

DOI

ISSN

0277-0008

Publication Date

July 2007

Volume

27

Issue

7

Start / End Page

970 / 979

Location

United States

Related Subject Headings

  • Voriconazole
  • Triazoles
  • Treatment Outcome
  • Pyrimidines
  • Pharmacology & Pharmacy
  • Neutropenia
  • Middle Aged
  • Male
  • Humans
  • Hospitalization