Introduction of an antifungal stewardship programme targeting high-cost antifungals at a tertiary hospital in Cambridge, England.
BACKGROUND
Antifungal stewardship aims to promote the optimal use of antifungals through the careful selection of agents based on patient profile, target organism, toxicity, costs and the likelihood of emergence and spread of resistance.


METHODS
We report on an observational prospective 12 month study conducted by an antifungal stewardship team targeting the use of echinocandins (caspofungin and micafungin), voriconazole and liposomal amphotericin B in a tertiary referral hospital in the UK.


RESULTS
One-hundred-and-seventy-three patients were reviewed on 294 occasions. Clinical advice was given and implemented during review of 45 (88.2%) of micafungin prescriptions, 70 (78.7%) of those receiving voriconazole, 78 (62.4%) of those receiving liposomal amphotericin B and 3 (27.3%) of those receiving caspofungin. Except for voriconazole, nearly half of all treatments reviewed were stopped or changed. This study found that a crude cost saving of ∼£180 000 in antifungal drugs was generated compared with the previous year.


CONCLUSIONS
Using a multidisciplinary team, antifungal stewardship can achieve significant improvements in patient management and it may reduce costs.
Pharmacy Department, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
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Micallef
Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge CB2 0QW, UK.
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Aliyu
Pharmacy Department, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
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Santos
Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge CB2 0QW, UK.
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Brown
Pharmacy Department, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
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Rosembert
Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge CB2 0QW, UK david.enoch@addenbrookes.nhs.uk.
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Enoch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D054714:Echinocandins / Q000627:therapeutic use; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D011446:Prospective Studies; D062606:Tertiary Care Centers; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
D000935:Antifungal Agents; D054714:Echinocandins; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole
caspofungin; liposomal amphotericin B; micafungin; voriconazole