C Poulat1, Y Nivoix2, A Launoy3, P Lutun4, P Bachellier5, S Rohr5, M-L Woehl5, D Levêque1, V Bru6, R Herbrecht7, B Gourieux1. 1. Pharmacy, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France. 2. Pharmacy, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France. Electronic address: yasmine.nivoix@chru-strasbourg.fr. 3. Surgical Intensive Care Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France. 4. Medical Intensive Care Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France. 5. Hepatobiliary, Pancreatic and Digestive Surgery Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France. 6. Institut de parasitologie et de pathologie tropicale, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France. 7. Oncology and Hematology Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France.
Abstract
OBJECTIVES: To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. METHODS: Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. RESULTS: Seventy-four treatments were analyzed. Treatments were prescribed for prophylactic (1%), empirical (22%), pre-emptive (16%), or targeted therapy (61%). Caspofungin accounted for 68% of prescriptions, followed by voriconazole (20%) and liposomal amphotericin B (12%). Indication was appropriate in 91%, debatable in 1%, and inappropriate in 8%. Dosage was appropriate in 69%, debatable in 8%, and inappropriate in 23%. Prescriptions were inappropriate for the following reasons: lack of dosage adjustment in light of the hepatic function (10 cases), underdosage or excessive dosage by>25% of the recommended dose in seven cases. De-escalation to fluconazole was implemented in 40% of patients presenting with a fluconazole-susceptible candidiasis. CONCLUSION: The overall incidence of appropriate use was higher in 2012 compared with 2007 (62% and 37% respectively, P=0.004). Nevertheless, costly antifungal prescriptions need to be optimized in particular for empirical therapy, dosage adjustment, and potential de-escalation to fluconazole.
OBJECTIVES: To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. METHODS: Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. RESULTS: Seventy-four treatments were analyzed. Treatments were prescribed for prophylactic (1%), empirical (22%), pre-emptive (16%), or targeted therapy (61%). Caspofungin accounted for 68% of prescriptions, followed by voriconazole (20%) and liposomal amphotericin B (12%). Indication was appropriate in 91%, debatable in 1%, and inappropriate in 8%. Dosage was appropriate in 69%, debatable in 8%, and inappropriate in 23%. Prescriptions were inappropriate for the following reasons: lack of dosage adjustment in light of the hepatic function (10 cases), underdosage or excessive dosage by>25% of the recommended dose in seven cases. De-escalation to fluconazole was implemented in 40% of patients presenting with a fluconazole-susceptible candidiasis. CONCLUSION: The overall incidence of appropriate use was higher in 2012 compared with 2007 (62% and 37% respectively, P=0.004). Nevertheless, costly antifungal prescriptions need to be optimized in particular for empirical therapy, dosage adjustment, and potential de-escalation to fluconazole.