[Changes in the pattern of use of non-conventional amphotericin B after the implementation of a training intervention at the San Carlos Clinical Hospital of Madrid].
BACKGROUND
Amphotericin B is the treatment of choice for systemic fungal infections. Among the different AB formulations available, the lipid forms appear to have a better profile of reliability, however, their cost is noticeably higher. In 1999 (pre-initiative period) an evaluation of the quality of the prescription of these preparations was made in our hospital, which revealed that they were not being used to best advantage and were responsible for generating a significant unnecessary expenditure. As a result of this, an information initiative was implemented with respect to the prescribing physicians for the purpose of reducing the inappropriate use of AB.


METHODS
The quality of 100 prescriptions was evaluated prospectively, according to the standards of use of Amphotericin B established in the hospital. Following each evaluation, a pharmacologist personally handed over to each prescribing physician a set of rules governing the use of the Amphotericin B, discussing the indication and recommending the best alternative in each case. In order to measure the impact of this initiative, the appropriateness of the prescriptions during this period was compared with the pre-initiative period.


RESULTS
The percentage of inappropriate prescriptions dropped from 58% to 21% following the implementation of the initiative. Likewise, a 33-million-peseta reduction in the total expenditure was achieved in 15 months as well as a savings of 24 million in inappropriate prescriptions.


CONCLUSIONS
The information initiative improved the quality of the prescribing of preparations of Amphotericin B associated with lipids and considerably reduced the unnecessary expense associated with Amphotericin B misuse in our hospital.
Prieto Yerro
C
C
Servicio de Farmacología Clínica Hospital Clínico San Carlos C/Doctor Martín Lagos, s/n 28040 Madrid. conchapy@hotmail.com
Laredo Velasco
L
L
Rodríguez Bernardino
A
A
Vargas Castrillón
E
E
Ambit Avila
I
I
Merchante Medina
A
A
D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006786:Hospitals, Urban; D006801:Humans; D011446:Prospective Studies; D013030:Spain
D000935:Antifungal Agents; D000666:Amphotericin B