title: Evaluation of conformity of a first prescription of lipid-based formulation of amphotericin B in a university-teaching pediatric hospital.
abstract: OBJECTIVE
  Invasive fungal infections are an important cause of morbidity and mortality in immunodeficient children. Amphotericin B is an important therapeutic agent for the treatment of invasive fungal infections but is associated with significant toxicities and high acquisition costs. The purpose of this study was to evaluate physician adherence to a local guideline for the use of lipid-based amphotericin B.
  
  
  METHODS
  The study was approved through Pharmacology & Therapeutics (P&T) committee activities. A retrospective drug utilization review (DUR) was conducted. All orders written between January 1, 2003, and December 31, 2004, were reviewed. Demographic and descriptive clinical data were collected as well as variables related to the drug order process. Conformity rates were calculated for the primary objective criteria (authorized prescribers - infectious disease members; recommended drug of choice-Abelcet; accepted indications; and presence of underlying conditions).
  
  
  RESULTS
  A total of 109 orders for 70 patients were reviewed by a single research assistant for a 2-year period. Global conformity rate for all four criteria was calculated at 7.3%. Non-conformity was mostly associated with the absence of underlying conditions (e.g., prerenal insufficiency or presence of nephrotoxicity due to amphotericin B desoxycholate) in 84.5% of the cases. Infusionrelated adverse drug reactions partly explained a switch to a non-formulary lipid-based amphotericin B product. External factors (newly published results since the adoption of the guideline and continuous marketing practices) and internal factors (availability of non-formulary process, inefficient DUR process) could have contributed to non-adherence to a local guideline.
  
  
  CONCLUSIONS
  This study shows low adherence to P&T committee drug guidelines on lipid-based amphotericin B. Continuous and efficient DUR processes should be in place to monitor drug guideline adherence.
authors.affiliation: Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, département de pharmacie.
authors.forename: Claire
authors.initials: C
authors.lastname: Agogué
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bussières
authors.forename: Catherine
authors.initials: C
authors.lastname: Dehaut
authors.forename: Denis
authors.initials: D
authors.lastname: Lebel
authors.forename: Marie-Sophie
authors.initials: MS
authors.lastname: Brochet
keywords: abelcet; ambisome; amphotericin B; drug utilization review; pediatrics