Use of systemic antifungals in daily clinical practice in the haematology and oncology setting: results of a prospective observational analysis.
OBJECTIVE
To assess the role of systemic antifungal drugs as well as the frequency of potential drug interactions and adverse drug events of commonly used antifungals in an unselected haematology/oncology patient cohort.


METHODS
A prospective analysis was performed in our haematology/oncology department between October 2006 and September 2009. Data were obtained from 250 consecutive patients who received treatment and/or prophylaxis with fluconazole (n = 191), liposomal amphotericin B (n = 105), voriconazole (n = 62), caspofungin (n = 27) and/or posaconazole (n = 22). We performed detailed reviews of patient charts and laboratory values in close cooperation with treating physicians and nursing staff and participated regularly in ward and chart rounds. Potential drug interactions were assessed using the electronic database Micromedex® 1.0 (Healthcare Series).


RESULTS
In terms of adverse drug events, caspofungin (56%) and voriconazole (58%) revealed a slightly more favourable safety profile than liposomal amphotericin B (66%) and posaconazole (64%). We confirmed frequent nephrotoxic effects with the use of liposomal amphotericin B (20%). Regarding potential drug interactions, 97 (66%) of 147 evaluated patients were exposed to at least 1 of 22 different potentially interacting drug combinations involving systemic antifungal agents. Cyclosporine was the most prevalent potentially interacting drug in our cohort.


CONCLUSIONS
Systemic antifungal drugs are widely used in the haematology/oncology setting and exhibit numerous potential drug interactions and adverse events in cancer patients. Our results highlight the challenges related to antifungal drugs and should valuably contribute to a safe and efficient application of this increasingly important class of drugs.
Department of Hematology and Oncology, University Medical Center Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Barbara
B
Metzke
Werner Christian
WC
Neubauer
Stefanie
S
Hieke
Manfred
M
Jung
Ralph
R
Wäsch
Monika
M
Engelhardt
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D005260:Female; D006405:Hematology; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies
D000935:Antifungal Agents