Appropriateness of antifungal prescribing in Oman

Abstract

Background: The inappropriate use of antimicrobials has substantially contributed to the development of antimicrobial drug resistance. Appropriate antibacterial prescribing has been emphasised, with minimal focus on appropriate prescribing of antifungals. Evaluation of antifungal use in the clinical setting is essential to prevent unnecessary drug exposure, development of resistance, adverse effects, and high hospitalisation costs. Objective: The purpose of this study was to assess the appropriateness of antifungal prescribing among adult patients at the Sultan Qaboos University Hospital (SQUH) in Oman. Methods: In this retrospective, observational study, the study population comprised adult patients treated with oral or intravenous antifungals between July 2018 and December 2019. The appropriateness of treatment was assessed using guidelines from the Infectious Diseases Society of America (IDSA) and the National Comprehensive Cancer Network (NCCN), as well as a set of literature-based criteria that were modified by SQUH infectious diseases team to suit local practices. These criteria included indication, dosage, and potential drug interactions. The primary outcome was the frequency of adherence to the treatment guidelines for fungal infections. Descriptive statistics were used for data analysis. Results: A total of 400 prescriptions were collected, of which 158 (39.5%) were for empirical therapy, 135 (33.8%) for targeted therapy, 69 (17.3%) for prophylactic therapy, and 38 (9.5%) for pre-emptive therapy. The overall appropriateness was 74.8%. The indication, dosage, and potential for antifungal-drug interactions were considered appropriate in 391 (97.8%), 314 (78.5%), and 381 (95.3%) prescriptions, respectively. Anidulafungin was the most prescribed antifungal agent, with 210 prescriptions (52.5%), followed by fluconazole with 102 prescriptions (25.5%), and voriconazole with 48 prescriptions (12%). Conclusion: In comparison with publised literature, our study revealed appropriate antifungal drug prescribing practices. However, studies with larger sample size in various hospital settings are necessary to confirm our findings on a national scale, and to obtain better statistical inferences and generalisability.

Study of Prescription-Indication of Outpatient Systemic Anti-Fungals in a Colombian Population. A Cross-Sectional Study

“…This study found that 29.3% of medications were prescribed in unapproved indications. There are few published studies that address this topic, with only a few on the inappropriate use of systemic antifungals in the hospital environment [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. For example, in Greece, researchers found that 25.0% of antifungal prescriptions were inappropriate [ 10 ], similar to that described in Spain (25.0%) [ 11 ] and Oman (25.2%) [ 12 ].…”

“…There are few published studies that address this topic, with only a few on the inappropriate use of systemic antifungals in the hospital environment [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. For example, in Greece, researchers found that 25.0% of antifungal prescriptions were inappropriate [ 10 ], similar to that described in Spain (25.0%) [ 11 ] and Oman (25.2%) [ 12 ]. In France, inappropriate use was higher (30.0–40.0%) [ 13 , 14 ], while in Brazil nonadherence to management guidelines was even more worrisome (64.6–80.2%) [ 15 , 16 ].…”

“…In addition, no studies on the use of antifungals could be found to determine their appropriate or inappropriate use in this group of patients. Studies have addressed this topic but involve only hospitalized patients, reflecting that the inappropriate use of these drugs is 25.0% to 80.2% [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Evaluation of Systemic Antifungal Use in a Latin American General Care Hospital: A Retrospective Study

“…Regarding the indication, it was deemed unnecessary to prescribe antifungals in these patients due to the absence of risk factors. Evidence suggests that such prescriptions only contribute to the potential development of antifungal resistance [ 15 , 24 , 25 , 26 ]. Regarding the dosing, adjustments should have been made to the fluconazole dose in two patients due to impaired renal function.…”

“…These criteria included indication, dosage, and potential antifungal–drug interactions (as outlined in Table 4 ). The use of antifungals was considered appropriate when all three evaluation criteria were met, debatable when at least one debatable assessment criterion was present without any inappropriate assessment criteria, and inappropriate when at least one inappropriate assessment criterion was present [ 15 , 16 ].…”