A Review of Liposomal Amphotericin B Drug Used at Srinagarind Hospital

Abstract

Background and objective : Liposomal Amphotericin B (LAMB) is a drug in group E (2) in the  national essential drugs 2551. Hospital must provide control measuring and appropriate prescribing approval system. In addition, drug use review or evaluation is also required to assure the reasonable drug utilization in terms of indication and other privacy statements. Review of LAMB use in various fields, including prescribing volume, justified indication, duration, drug use indicators and effectiveness of drugs is a practice tool according to the measures which will support the rational use of drugs and a great value.

Method: This retrospective descriptive study collected data from medical record of inpatients who received LAMB at Srinagarind hospital from October 1, 2004 to September 30, 2011.

Results: LAMB were used in 26 patients but only 16 patients were recruited into the study and 12 patients were males (75.00%). The average age of patients was 45.72 ± 15.44 years old. The total amounts of drug used were 237 vials and cost 2,100,057 Baht. LAMB were used as empiric therapy in 8 patients for protecting the mycosis after undergoing liver transplantation and 1 patient who underwent abdominoplasty surgery. The indications of document therapy were used in 3 cases of aspergillosis, 2 cases of cryptococcosis, 1 case of mucormycosis sinus, and 1 case of candidiasis. The drug dose in empiric therapy was 0.57-0.96 mg/kg/day meanwhile in document therapy was about 2.42-4.00 mg/kg/day. For the drug indicators, all patients had been undertaken culture and sensitivity testing for microorganism. Moreover, the patients had been checked for complete blood count and serum creatinine both before and during the treatment. For the outcome of treatments, fever was subsided within three days in 5 patients (31.25%), white blood cells were return to normal in 3 patients (18.75%) and microorganisms were disappeared in 2 cases (12.50%). Regarding to discharge status, improve, not improve and dead were indicated in 9 (56.25%), 2 (12.50%) and 5 (31.25%) patients, respectively.

Conclusion: The use of LAMB as documented therapy was mostly appropriate in the terms of indications, process indicators of drug utilization and dosage regimen meanwhile the empirical therapy was inappropriate in term of dosage regimen.