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An audit of the use of antifungal agents
F Gutiérrez1, P G Wall, J Cohen
1Servicio de Medicina Interna-Infecciosas, Hospital SVS Marina Baixa, Villajoyosa, Alicante, Spain.
Abstract:
The three month prospective audit of systemic antifungal therapy was undertaken in a university hospital in the United Kingdom to determine the patterns of usage of systemic antifungal drugs. The case notes of all patients receiving systemic antifungal agents were reviewed daily and the appropriateness of therapy was determined according to standards in the authoritative literature. One hundred and fifteen courses of treatment with antifungal agents for 1481 days were administered to 74 patients. When a patient has received more than one course of antifungals, both the individual courses and the combination of courses, i.e. a regimen, were judged. Antifungal agents were given as an empirical therapy or as prophylaxis in 68% of the courses, with fluconazole and amphotericin B desoxycholate being the agents most frequently used. Therapy was considered unconventional in 26.9% of the courses and 40.5% of the regimens, mainly because either the indication or the duration of treatment did not conform to conventional practice. Improvement in prescribing practices and standards for ongoing audit can only be achieved if a consensus can be reached on how these agents can be used appropriately.
Insights
This audit of systemic antifungal therapy found that nearly 27% of treatments and 40% of regimens were unconventional. Reaching a consensus on appropriate use is crucial for improving prescribing practices.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hospital Pharmacy
Background:
- Systemic antifungal agents are crucial for treating fungal infections.
- Variations in prescribing practices can impact patient outcomes and resource utilization.
- A clear understanding of current usage patterns is needed to establish best practices.
Purpose of the Study:
- To audit the patterns of systemic antifungal drug usage in a UK university hospital.
- To assess the appropriateness of antifungal therapy based on established literature standards.
- To identify areas for improvement in antifungal prescribing.
Main Methods:
- A three-month prospective audit of systemic antifungal therapy.
- Daily review of patient case notes for all patients receiving systemic antifungals.
- Evaluation of therapy appropriateness against authoritative literature standards.
- Assessment of individual treatment courses and overall treatment regimens.
Main Results:
- 115 courses of antifungal therapy were administered over 1481 days to 74 patients.
- Antifungal agents were used empirically or prophylactically in 68% of courses.
- Fluconazole and amphotericin B desoxycholate were the most frequently used agents.
- 26.9% of courses and 40.5% of regimens were deemed unconventional.
- Deviations were primarily due to non-standard indications or treatment durations.
Conclusions:
- Significant proportions of systemic antifungal therapy courses and regimens did not conform to conventional practice.
- There is a need for consensus on appropriate systemic antifungal agent utilization.
- Improved prescribing practices and ongoing audits are necessary to optimize antifungal therapy.