Institutional Experience with Voriconazole Compared with Liposomal Amphotericin B as Empiric Therapy for Febrile Neutropenia

• DOI: 10.1592/phco.27.7.970
• Publication Date: 2007-06-26T15:00:02Z
• Authors: Nadine Shehab; Daryl D. DePestel; Emily R. Mackler; Curtis D. Collins; Kathleen Welch; Harry P. Erba
• Keywords: Discontinuation; Empiric therapy

To assess the effectiveness, safety, and cost of empiric treatment febrile neutropenia before after implementing an algorithm in which voriconazole was substituted for liposomal amphotericin B (L-AmB).Retrospective cohort analysis.An 850-bed tertiary care hospital, is also a referral site patients with acute leukemia.Fifty-five adult who started antifungal therapy between January 1, 2002, December 31, 2003, encompassing 58 episodes (defined as hospitalization during administered).Medical charts, including patients' pharmacy laboratory data, were reviewed. Twenty-six 32 L-AmB use, respectively, identified. No significant differences groups noted at baseline. Rates fever resolution (54% vs 59%, p=0.791) breakthrough invasive fungal infections (11% 12%, p>0.999) similar episodes. Premature drug discontinuation due to prescriber's perceived lack efficacy occurred most frequently group (25% 8%, p=0.160). Survival significantly higher than (100% 77%, p=0.006). Adverse effects that more common elevated serum creatinine levels (27% 3%, p=0.017) electrolyte disturbances (19% 0%, p=0.014). reported visual (9% p=0.245) hepatic enzyme p>0.999). Mean expenditures/episode initial lower ($1593 $4144, or $153 $380/day).Our institution's incorporating into management associated effectiveness outcomes comparable those observed well frequency adverse overall expenditures drugs.