Developing and implementing guidelines to promote appropriate use of fluconazole therapy in an AIDS clinic

A retrospective and concurrent drug use evaluation for fluconazole in an outpatient AIDS clinic is described. Eighty-eight patient charts were reviewed in the evaluation during an 8-week period, and 72 patients were studied in the concurrent evaluation for a period of 5 weeks. A set of preestablished fluconazole usage and dosing guidelines was developed by the clinical pharmacist and the chairman of the antimicrobial subcommittee/chief of infectious disease and approved by the pharmacy and therapeutics committee. Patients who did not meet these guidelines were those being treated for oropharyngeal and esophageal candidiasis. The use of fluconazole was not indicated in 43 of 54 (80%) patients in retrospective evaluation and 31 of 39 (79.5%) patients before clinical pharmacist intervention in concurrent study. If guidelines had been followed during the retrospective evaluation, cost savings would have been $295 per day, which adds up to $16,520 for 8 weeks. In the actual evaluation, the cost savings with pharmacist intervention for 5 weeks was $5,460, which can be extrapolated to annual cost savings of $65,520.