Adherence to recommendations for the use of antifungal agents in a tertiary care hospital.
OBJECTIVE
The aim of our study was to assess the adherence to labelling and international guidelines for antifungal prescribing.


METHODS
A retrospective study was performed in intensive care units in addition to the oncology and haematology department, which covered 70% of antifungal consumption at Hautepierre Hospital, Strasbourg, France. On reviewing medical charts, the antifungal prescription was examined in relation to the recommendations of indication, dosage, risk of drug-drug interactions and, where appropriate, antifungal susceptibility testing. Treatments were considered appropriate, inappropriate or debatable.


RESULTS
Between January and April 2007, 199 treatments were given for 179 different episodes in 133 adult patients. Treatments were prescribed for pre-emptive or targeted therapy (n = 90, with 60 for candidiasis, 26 for aspergillosis and 4 for other mould diseases), empirical therapy (n = 17) and primary (n = 81) or secondary (n = 11) prophylaxis. Fluconazole accounted for 67% of prescriptions, followed by voriconazole (19%), caspofungin (10%), posaconazole (2%), conventional or liposomal amphotericin B (2%), itraconazole (<1%) and terbinafine (<1%). Indication and dosage were found to be appropriate in 65% and 62% of cases, inappropriate in 22% and 21%, and debatable in 13% and 17%, respectively. The overall (by combining all assessment criteria) rate of inappropriate use was 40%. The overall survival rate at 12 weeks was highest in patients receiving appropriate therapy (81% versus 72% and 68% in the debatable and inappropriate therapy groups, respectively), with between-group differences not being significant (P = 0.49).


CONCLUSIONS
Our evaluation revealed a high proportion of inappropriate or debatable use of antifungal agents, while highlighting significant issues, such as inadequate dosage or indications.
Pharmacy, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. yasmine.nivoix@chru-strasbourg.fr
Yasmine
Y
Nivoix
Anne
A
Launoy
Philippe
P
Lutun
Jean-Charles
JC
Moulin
Katy-Anna
KA
Phai Pang
Luc-Matthieu
LM
Fornecker
Michèle
M
Wolf
Dominique
D
Levêque
Valérie
V
Letscher-Bru
Laurence
L
Beretz
Geneviève
G
Ubeaud-Sequier
Raoul
R
Herbrecht
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control*; D016522:Oncology Service, Hospital; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
D000935:Antifungal Agents