Antifungal prescription practices and consumption in a tertiary care hospital of a developing country

Abstract

Background Antifungal stewardship is a less explored component of antimicrobial stewardship programmes, especially in developing countries. Objective We aimed to determine antifungal prescription practices in a tertiary centre of a developing country to identify the challenges for antifungal stewardship programmes. Methods Four single‐day point prevalent surveys were performed in inpatient units and data were collected from medical records. Antifungal use was recorded in terms of consumption, therapeutic strategies and appropriateness. Results We found a 2.42%‐point prevalence of antifungal prescriptions. Antifungal use was higher in children than adults (4.1% vs. 2.03%), medical than surgical units (3.7% vs. 1.24%) and ICUs than general wards (5.8% vs. 1.9%). The highest antifungal use was observed in the haematology‐oncology units (29.3%) followed by emergency (16.2%) and gastroenterology units (11.6%). Among 215 prescriptions, amphotericin B was the most commonly prescribed (50.2%) followed by fluconazole (31.6%). The targeted antifungal therapy was practised more commonly (31.5%) than empiric (29.1%), pre‐emptive (22.6%) and prophylactic (16.8%) therapy. Amphotericin B was commonly used for pre‐emptive (p = .001) and targeted (p = .049) therapy, while fluconazole (p = .001) and voriconazole (p = .011) for prophylaxis. The prescriptions were inappropriate in 25.1% due to the wrong choice of antifungal (44.4%), indication (27.7%) and dosage (24%). The overall mean antifungal consumption was 2.71 DDD/1000 PD and 8.96 DOT/1000 PD. Conclusions We report here the low prevalence of antifungal use at a tertiary care centre in a developing country. Though training for antifungal use would be important for antifungal stewardship, the challenge would remain with the affordability of antifungals.

Multi-arm ε-polylysines exhibit broad-spectrum antifungal activities against Candida species

“…Antibiotic resistance is a major threat to human health; to date, human infecting pathogenic fungi are evolving resistance to all licensed systemic antifungal drugs. [28][29][30] The antifungal resistance and killing kinetics studies were performed on C. albicans using 3R-K7 and 4R-K5 that had the same number of lysine residues. C. albicans did not acquire resistance even after being treated with 3R-K7 or 4R-K5 at a sublethal dose (1/8 MIC) for 14 days.…”