Amphotericin B deoxycholate: no significant advantage of a 24 h over a 6 h infusion schedule

Sir, Lambert et al. 1 reported on the effect of two sequential mass media campaigns, providing information on the appropriate use of antimicrobials. We acknowledge that evaluating such campaigns can be problematic and that uncontrolled observations can be misleading. Nonetheless, as the authors state too, ensuring equivalence of the study groups in a controlled study can also be cumbersome. Given the evidence linking antibiotic use with resistance both at ecological 2 and individual levels, 3 and of the overuse of antibacterials in many countries, 2,4 we compared the results of their controlled study of a regional intervention with those of national public campaigns in two high consuming countries, France (Before-and-after assessments showed a reduction in new anti-bacterial prescriptions per inhabitant over a 6 month period of 13% (19% in children aged under 15 years) 3 years after the start of public campaigns in France. 5 In Belgium, the antibacter-ial use expressed in defined daily doses per 1000 inhabitants per day (DID) decreased by 6.5% (P , 0.05) and 3.4% (non-significant) after the first and second campaigns, respectively, yielding a saving/cost ratio of 5.54. 5,6 The effect on the prescribing behaviour of ambulatory care physicians in Belgium might however be underestimated using DID as an outcome measure, because during these years, the content of an average pack increased (both by increase of strength and of pack size). After all, expressing antibacterial use in packages—a proxy for prescriptions—per 1000 inhabitants per day shows an average decrease of 6.9% (SD ¼ 2.0) for 5 years since the start of the Belgian public campaigns in the 2000 –01 winter season (Figure 1). As their effect in the Northeast of England, France and Belgium is similar, we believe one can be quite confident that public campaigns are (cost)effective interventions to improve antibacterial prescribing on both regional and national levels. None to declare. References 1. Lambert MF, Masters GA, Brent SL. Can mass media campaigns change antimicrobial prescribing? A regional evaluation study. Stichele RV et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Impact of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci among healthy volunteers: a randomised, double-blind, placebo-controlled study. Sir, In a publication in this journal, Peleg and Woods 1 described a retrospective analysis demonstrating reduced toxicity and improved survival in neutropenic patients receiving amphotericin B deoxycholate (AmB) by continuous infusion. AmB is a broad-spectrum antimycotic …