Different patterns of inappropriate antifungals use in daily practice: A single center experience

• Autores: Caroline Briquet, Cristina Martínez Múgica Barbosa, Bernard Vandercam, Leila Belkhir, Jean Cyr Yombi
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 20, Nº. 4, 2018, págs. 189-196
• Idioma: inglés
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• Resumen

  • The use and cost of antifungal are increasing. There is an urgent need to change prescribing practice. Objective: Our aim was to identify different patterns of inappropriate antifungal use in daily practice in our center (Cliniques Universitaires St Luc, Brussels). Setting: A 989 bed teaching hospital in Belgium. Method: Four point prevalence surveys (PPS) were undertaken prospectively during February, March, August 2014 and March 2015. One infectious disease specialist and two pharmacists assessed the quality of antifungal treatments according to standard guidelines. Antifungal use was evaluated by a modified algorithm used for antimicrobial use evaluation considering indication, dosage and duration of treatment. Main outcome measure: To assess the quality of use of antifungal agents in terms of indication, choice of molecule, dosage and duration of treatment. Toxicity and potential drug-drug interactions were also evaluated. Results: 108 antifungal therapies were prescribed to 104 patients during the four PPS. Fifty eight therapies were prophylactic indications (54%). 51.3% of the therapeutic indications were empirical and 21.3% targeted therapies. Fluconazole was the most frequently used drug (61.1%), followed by voriconazole (13%). According to Gyssens algorithm, only 61 prescriptions (56.5%) were judged definitely appropriate. Indications were considered correct in 93.5% (101). In 11.9% of cases the antifungal drug was not chosen correctly. The correct dose of antifungal drugs was prescribed in 75.9%. Conclusion: These four PPS days identified different patterns of inappropriate antifungal use that should be improved by education and feedback of these results of prescribing habits. This kind of interventions is one of the most successful means of influencing physicians' performance