Drug Utilization Review of Conventional Amphotericin B in Febrile Neutropenic Patients Hospitalized at a Bone Marrow Transplant Center

Abstract

Introduction: Conventional amphotericin B is one of the antifungal choices as prophylactic and empiric treatment against fungal infections in febrile neutropenic patients. However the time of initiation, dosing and monitoring of drug adverse effects must be justified to maximize the efficacy and minimize the toxicities of this antifungal agent.
Methods: We conducted a prospective observational study at Shariati teaching hospital, Hematology – Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences to evaluate the appropriateness of amphotericin B utilization for our adult bone marrow transplant (BMT) patients for a period of six months.
Results: The charts of a total of 54 patients in 3 adult BMT wards were prospectively evaluated. Most patients underwent allogienic transplantation (61.1%).  The mean duration of treatment with amphotericin was 9.3 days with 50% as prophylactic and 42.6% as empiric treatments. Appropriate dose was initiated in 70.4% of patients versus 22.2% unjustified initial doses. The use of amphotericin was appropriate in 92.6% of cases versus 7.4% unjustified uses.
Conclusion: Based on the results of this study, in the majority of our BMT patients amphotericin B was utilized appropriately either as prophylactic or empiric treatment. More attention in dose adjustment seems to be necessary to minimize nephrotoxicity and other adverse effects of this agent.