Fluconazole dosing in renal impairment: a drug usage evaluation

Area of Science:

• Pharmacology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Fluconazole is a widely used antifungal medication for various infections.
• Appropriate dosing is critical and depends on infection severity, causative organism, renal function, and patient response.
• Intravenous (IV) administration requires careful consideration of these factors.

Purpose of the Study:

• To evaluate the appropriateness of IV fluconazole dosing at St. Joseph Hospital.
• To identify potential discrepancies in drug dosage based on established parameters.
• To assess the impact of renal function and infection characteristics on fluconazole administration.

Main Methods:

• A 3-month drug usage evaluation was conducted by the hospital's pharmacy department.
• Data collection focused on IV fluconazole prescriptions and patient-specific factors.
• Analysis included assessment of dosing against infection type, severity, and renal function (creatinine clearance).

Main Results:

• A significant proportion of patients received inappropriate fluconazole dosages.
• Renal function was not considered in the dosing of 30% of patients.
• 33% of patients were administered higher doses than necessary based on infection site and severity.

Conclusions:

• The drug usage evaluation revealed widespread issues with IV fluconazole dosing.
• Lack of consideration for renal function and over-dosing based on infection characteristics were key findings.
• An educational intervention was implemented to guide physicians toward appropriate fluconazole dosing practices.