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Background The recent marketing of new high-cost antifungal agents (echinocandins and azoles) requires the design of cost-effective treatment protocols. Purpose A new treatment guide for candidaemia and other invasive fungal infections for non-haematology adult patients was approved in June 2011. The main objective was to evaluate the cost reduction by introducing this protocol in a 737-bed University Hospital serving a population of more than 400,000 inhabitants. Materials and Methods Retrospective observational study between June and December 2011. We reviewed the medical records of patients whom were prescribed antifungal treatment during that time and we assessed the adjustment to the approved treatment guidelines. To quantify the avoided costs we extracted consumption data and costs of antifungals from the pharmacy service management system (SAP®) and compared them with the same period the previous year. Results During the study 43 non-haematology patients were treated with antifungal agents. In 38 patients (88.4%) the approved treatment guidelines were followed and in 5 patients (11.6%) they were breached.The most significant breaches occurred in internal medicine (22.2%) and in critical care (3.7%). Regarding avoided costs for the six months of the study, antifungal costs were reduced by 240,616 euros. We observed a 61.9% and 48% increase in use in fluconazole and anidulafungin, and a 42.8% and 41.7% decrease in caspofungin and liposomal amphotericin B use. These results are consistent with the recommendations contained in the guide (first line use of fluconazole in non-immunosuppressed patients and in azole resistance use anidulafungin). Micafungin use was restricted to the paediatric population with consumption equal to that in the previous period. Conclusions The treatment guideline compliance was excellent at our hospital, resulting in a significant decrease in antifungal expenses. Implementation of these guidelines in the management of high-cost drugs resulted in significant cost reductions and therefore in a more rational use of healthcare budgets. No conflict of interest.

BackgroundMultiple sclerosis (MS) is a chronic and inflammatory neurological disease in which focal demyelination occurs in the CNS. Dimethyl fumarate (DMF) is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis. It is administered orally. The dose is 240 mg twice daily; 120 mg twice daily for the first 7 days.PurposeOur goal was to analyse the profile of patients and tolerability of DMF.Material and methodsA retrospective observational study was constructed from October 2014 to May 2015.SAP software was used for medical history, nursing and recording dispensations of patients treated with DMF. Data recorded were: age, sex, EDSS, pretreatment, analytical performed and adverse reactions.Results16 patients, 11 women and 5 men, with a mean age of 39.31 years (16–63) were analysed. Mean EDSS was 2.4 (1–4.5).DMF was prescribed as the firstline treatment in 5 patients (31.25%), as secondline in 7 (43.75%), as the third treatment in 3 (18.75%) and as the fourth treatment in 1 (6.25%).DMF was given immediately before treatment with interferon beta-1b 250 µg in 4 patients, interferon beta-1a 30 µg and 44 µg interferon beta-1a in 3 and glatiramer acetate 1. In all cases, the reason for the change was pain and skin reactions, flu-like syndrome uncontrolled in two cases and radiographic progression in one.All patient analyses were performed to assess renal function, liver function and blood count 1 month after starting treatment, and at 3 and 6 months.5 (31.25%) patients had mild to moderate disease at baseline, 1 (6.25%) patient experienced flushing and elevated liver transaminases more than three times the normal value and 3 (18.75%) patients had major digestive problems, with 2 (12.5%) suspending treatment despite starting treatment using a gradual protocol: doses of 120 mg-0–120 mg for the first week, 120 mg-0–240 mg for the second and third weeks, and full dose 240 mg-0–240 mg from the fourth week, trying to reduce subsequent doses.Mean duration of treatment with DMF was 4.56 months  (2–8).ConclusionDMF was accepted well by patients after oral administration despite its side effects (mainly flushing and gastrointestinal effects) that appeared at the start of drug treatment.The adverse reaction profile observed was similar to that described in the product information.References and/or Acknowledgements No conflict of interest.