Background and Importance The impact of COVID-19 and its influence in the management of hospitalised patients has been indisputable. Many publications present combinations of different antimicrobials to treat the patients infections, and the liposomal amphotericin b (Amb-L) is an example of one of the most prescribed.
Aim and Objectives To compare the prescription and indication of AmB-L in a tertiary hospital before and during the COVID-19 pandemic.
Material and Methods Observational, retrospective, descriptive study of patients prescribed AmB-L from March-2020 to March-2021, and the comparision to the year before the pandemic.
Results 58 patients analysed: 40 (69%) men, median age 71 years (IQR 54.5-75.2), and 18 (31%) women, median age 63.5 years (IQR 49.5-71.25). The months in which more patients received AmB-L were: July 2020 (6/56), December 2020 (7/56) and February 2021(12/56).
-39 (69.6%) CRITICAL patients. Out of these: 22 with a covid diagnosis, 14 non-covid and 3 onco-haematological. 26/39 patients received AmB-L as a targeted treatment for Candida Glabrata and Albicans(16/26), Aspergillus Fumigatus (6/26) and Mucor (4/26). As a concomitant therapy, anidulafungin and isavuconazole were the preferent ones. The most prescribed dose of AmB-L was 400 mg (5 mg/kg) with a median of 7 days of treatment (IQR 4-17.5). 86.4% out of the total experienced death.
-17 (30.4%) NON-CRITICAL patients: 0 covid patients, 6 (35.3%) non-covid and 11 (64.7%) onco-haematological patients. 10 (58.8%) patients received AmB-L as empirical treatment for febrile neutropenia, with posaconazole and itraconazole as the most commonly used antifungals. The most prescribed dose was 200 mg (3.3 mg/kg) for a median of 9 days (IQR 6-16).
In the previous year (March 2019 to February 2020) we observed: 17 patients received treatment with AmB-L, 53% (9/17) onco-haematological, 12 men with a median of 53 years (IQR: 38.2-59.1). Most prescribed dose: 180 mg (3mg/kg).
Conclusion and Relevance The data observed in this period reflects how the prescription of AmB-L tripled compared to the previous year. It targets a completely different profile: unstable patients, with invasive lung disease, risk factors in critical care units, treated with high doses of AmB-L. The fact of being an antifungal with a high cost/day per patient, the way of monitoring the situation of this type of patient is a crucial strategy to guarantee efficiency and optimise pharmaceutical spending.
Conflict of Interest No conflict of interest
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