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Pediatric Antifungal Prescribing Patterns Identify Significant Opportunities to Rationalize Antifungal Use in
Laura Ferreras-Antolín1,2, Adam Irwin3,4, Ayad Atra5
1From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom.
The Pediatric Infectious Disease Journal
|November 16, 2021
Summary
Pediatric antifungal use, particularly liposomal amphotericin B, is high, often without confirmed invasive fungal disease (IFD). Many children not at high risk received prophylactic or empiric antifungals.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacy
Background:
- Increasing antifungal consumption in children necessitates stewardship programs.
- Identifying drivers of antifungal prescribing is crucial for optimizing pediatric care.
Purpose of the Study:
- To analyze antifungal prescribing patterns in pediatric patients.
- To evaluate the appropriateness of antifungal use in a UK multicenter cohort.
Main Methods:
- Prospective Point Prevalence Survey of antifungal prescriptions in 12 English pediatric centers.
- Data collection on patient demographics, diagnoses, and antifungal treatments.
- Utilized an online REDCap database for data management.
Main Results:
- 1258 prescriptions for 656 pediatric patients (median age 6.4 years) were analyzed.
- Antifungals were predominantly used for prophylaxis (63.9%) versus treatment (36.1%).
- A significant proportion of prophylaxis (40.2%) and treatment (45.9% suspected IFD) lacked clear evidence of invasive fungal disease (IFD).
- Liposomal amphotericin B was the most common agent; 11.0% received combination therapy.
Conclusions:
- Pediatric antifungal prescribing, dominated by liposomal amphotericin B, frequently occurs without confirmed invasive fungal disease (IFD).
- A substantial percentage of pediatric patients not considered high-risk received prophylactic or empiric antifungals, indicating potential areas for stewardship intervention.
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