A comparision of several formats of amphotericin B as an inhaled antifungal prophylaxis

Abstract

Objective: We sought compare the economic cost, ease of preparation and administration, and tolerance of the available alternatives of amphotericin B (AmpB) as an inhaled antifungal prophylaxis for lung transplant patients.

Materials and methods: Doses administered and cost of the 3 formats: desoxycholate (desoxy; 50-mg vial); lipid complex (lipid; 100 mg/20 mL vial) and liposomal (lipos; 50-mg vial). The regimen for antifungal prophylaxis is as follows: AmpB desoxy (reconstituted and dilute): 5 mg/every 8 hours for 4 months and 5 mg/d in the following months; AmpB lipid (nonreconstituted): 25 mg/d for 7 days, 25 mg over 48 hours for days and 25 mg/wk; AmpB lipos (reconstituted): 24 mg 3 times weekly for 2 months, 24 mg/wk for 6 months and 24 mg every 2 weeks. We polled 8 nurses who prepare these drugs habitually. We also asked a random sample of treated patients regarding tolerance.

Results: Number of doses, vials per year per patient, and final cost for each type were: Desoxy, 609 doses, 72 vials, 607.90 euros; lipid, 63 doses, 15 vials, 1428 euros.15; and lipos, 57 doses, 57 vials, 7720.10 euros. Amp B lipid is considered to be the easiest to use, because it does not have to be reconstituted. The following cases of intolerance were recorded: AmpB desoxy 5 (45); AmpB lipid 1 (67); AmpB lipos 0 (4).

Conclusions: AmpB desoxy is the most economical, but it requires greater care in handling, the highest number of doses, and has the worst tolerance. AmpB lipid has an intermediate price and is the easiest to prepare. AmpB lipos is the most expensive and it requires careful handling.