title: [Clinical audit on the use of expensive systemic antifungals in the Besançon University Hospital].
abstract: The continuous improvement policy for healthcare quality requires practice evaluation. The principle of a clinical audit is to compare practice to guidelines. Prescription guidelines on antifungal agent use has been available in our hospital since 2003. It was updated in 2005 and 2006.
  
  
  OBJECTIVE
  The aim of this study was to assess compliance to guidelines, with an audit of prescriptions: amphotericin B lipid formulation, voriconazole and caspofungin, expensive antifungals concerned by the budget allowance correlated to activity, subject to supplementary reimbursement to the coded Homogeneous Group of Diseases.
  
  
  METHODS
  The assessment criteria were: relevance of the indication, absence of a better alternative, complying to recommended dosage, loading dose and timing. This retrospective study dealt with all prescriptions of all departments, from January to May 2007.
  
  
  RESULTS
  Hundred and eighteen prescriptions were retrospectively analyzed for 81 patients. The rate of overall conformity was 54%. Antifungal therapy was justified for 113 prescriptions (96%). In 30% of the cases, a more efficient alternative was advised, cheaper or less toxic. The dosage and the charge dosing were right in 92% and 80% of the cases respectively.
  
  
  CONCLUSIONS
  This audit allowed assessing good-use of antifungals. We showed an over-prescription of caspofungin and sometimes insufficient regimen of voriconazole dosages for children. Reporting these audit results and development of new international guidelines stress the need to update local recommendations regularly.
authors.affiliation: Pôle pharmaceutique, CHU de Besançon, 25030 Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Raymond
authors.forename: T
authors.initials: T
authors.lastname: Henon
authors.forename: F
authors.initials: F
authors.lastname: Grenouillet
authors.forename: F
authors.initials: F
authors.lastname: Legrand
authors.forename: M-C
authors.initials: MC
authors.lastname: Woronoff-Lemsi
authors.forename: B
authors.initials: B
authors.lastname: Hoen
authors.forename: S
authors.initials: S
authors.lastname: Limat
authors.forename: J
authors.initials: J
authors.lastname: Leroy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000592:standards / Q000627:therapeutic use; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D054869:Clinical Audit / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards; D005602:France; D006785:Hospitals, University / Q000191:economics / Q000592:standards; D006801:Humans; D055553:Prescription Drugs / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D055553:Prescription Drugs; D000666:Amphotericin B