International Journal of Clinical Pharmacy

, Volume 34, Issue 4, pp 611–617 | Cite as

Evaluating real-life clinical and economical burden of amphotericin-B deoxycholate adverse reactions

  • Ehud HorwitzEmail author
  • Oren Shavit
  • Rivka Shouval
  • Amnon Hoffman
  • Mervyn Shapiro
  • Allon E. Moses
Research Article


Background Amphotericin-B (AMB) is associated with toxicity such as renal impairment, hypokalemia and infusion-related events (IRE). With the advent of AMB lipid formulations and newer antifungal drugs, presenting improved safety profiles, it was suggested that using the conventional deoxycholate (AMB-D) formulation should no longer be regarded acceptable. Objectives Evaluation of real-life incidence of AMB-D-related adverse-drug effects (ADE) and associated costs. Setting Hadassah Hebrew University Medical Center, Jerusalem, Israel, a tertiary 1,100-bed teaching hospital. Methods A 1-year single-center prospective observational study following all patients administered AMB-D. Various parameters related to AMB-D administration were recorded. Main outcome measures Subsequent ADE-related events, discontinuations, switch to alternative antifungals and related resource-utilization were monitored. Results Among 119 patients (60 children, 59 adults) receiving AMB-D, serum creatinine doubling from baseline, hypokalemia and IRE occurred in 14.3 % (15 % in children, 13.6 % in adults), 16.8 % (16.6 % in children, 16.9 % in adults) and 10.9 % (10 % in children, 11.8 % in adults), respectively. AMB-D was discontinued due to an ADE in 12.6 % of patients (6.7 % in children, 18.6 % in adults). The total annual cost associated with AMB-D use was €58,600. Conclusion The clinical as well as economic burden of AMB-D associated ADE, as observed in real-life settings, appears to be manageable. Considering the significant cost implications associated, as suggested by simulated evaluation of an overall theoretic replacement of AMB-D by an equivalent volume of alternative antifungals, total abandonment of AMB-D appears unjustified.


Adverse-effects Amphotericin-B Antifungals Cost-effectiveness Israel Resource utilization 






Conflicts of interest

None to declare [O. S. has disclosed being employed by Merck-Israel, Distributor of caspofungin (Cancidas)®, beginning after completion of data collection and analysis].


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Ehud Horwitz
    • 1
    • 2
    Email author
  • Oren Shavit
    • 2
  • Rivka Shouval
    • 1
  • Amnon Hoffman
    • 2
  • Mervyn Shapiro
    • 3
    • 4
  • Allon E. Moses
    • 3
  1. 1.Pharmacy DivisionHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Department of Pharmaceutics, Faculty of Medicine, School of PharmacyThe Hebrew UniversityJerusalemIsrael
  3. 3.Department of Clinical Microbiology and Infectious DiseasesHadassah-Hebrew University Medical CenterJerusalemIsrael
  4. 4.Unit of Infectious DiseasesTel-Aviv Sourasky Medical CenterTel AvivIsrael

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