Inappropriate Use of Antifungal Medications in a Tertiary Care Center in Thailand: A Prospective Study

Sutepvarnon, Apisada; Apisarnthanarak, Anucha; Camins, Bernard; Mondy, Kristin; Fraser, Victoria J.

doi:10.1086/587633

Cited by 36 publications

(22 citation statements)

References 9 publications

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“…The use of antifungal drugs poses a daily challenge for professionals in many different specialties in modern hospitals . There are reportedly many inappropriate uses of triazole drugs in the United States, France, Spain and Thailand in terms of indications, drug dosages, duration of drug usage and other aspects which are due to guidelines not being followed.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey

Dong

Zhang

et al. 2017

J Clin Pharm Ther

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Contrasted with previous studies that have only focused on a subset of indicators, this research establishes comprehensive indicators for evaluating the use of triazoles for invasive fungal disease and which cover most of the medication process: indications, therapeutic timing, duration of drug usage, drug dosage, administration method, drug interactions, medication in specific populations and pharmaceutical care. The indicators can reflect the characteristic of triazoles throughout the process of clinical administration for an invasive fungal disease, and it will be helpful as references when hospital administrators are regulating the use of antifungals.

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Section: What Is Known and Objectivementioning

confidence: 99%

Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey

Dong

Zhang

et al. 2017

J Clin Pharm Ther

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“…In a study of antifungal use at a tertiary care centre in Thailand, inappropriate use was identified in 70% (42/57) of cases . Multivariate analysis found that isolation of Candida species from urine was associated with inappropriate antifungal use, whereas receipt of an infectious disease consultation was protective against inappropriate use.…”

Section: Appropriateness Rates For Antifungal Drugs Are Lowmentioning

confidence: 99%

Antifungal stewardship in daily practice and health economic implications

Muñóz

Valerio

Bouza

2015

Mycoses

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SummaryDuring recent years, inappropriate antifungal use has contributed to the global increase in antifungal resistance and has played a role in the shift in the aetiology of invasive fungal infections. Moreover, overuse of antifungals may also lead to higher toxicity associated with unnecessary medication exposure and to increased healthcare costs. Antifungal stewardship (AFS) programmes consist of multidisciplinary interventions, led by specialists in infectious disease, microbiology and pharmacy that cooperate and communicate with the major prescribing departments in order to optimise antifungal therapies evaluating the indication, dose, streamlining and duration. Herein, we review the available evidence for the use of AFS and their impact on health economics. We also describe our AFS program, the successive steps we followed and the main difficulties we found.

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“…For quality assessment of IFI prophylaxis and treatment in routine care, evidence‐based guidelines have been used as the benchmark criteria. Analyses in different countries using guidelines for quality assessment of antifungal treatment have shown areas for improvement by classifying 40%‐43% of antifungal prescriptions as inappropriate . Data on the quality of IFI prophylaxis and therapy in German hospitals are limited.…”

Section: Introductionmentioning

confidence: 99%

“…Analyses in different countries using guidelines for quality assessment of antifungal treatment have shown areas for improvement by classifying 40%-43% of antifungal prescriptions as inappropriate. [18][19][20][21] Data on the quality of IFI prophylaxis and therapy in German hospitals are limited. As frequently discussed, randomised controlled trials refer to a precisely defined design and a homogenous and selected patient population, while in clinical practice, patients are much more heterogeneous.…”

mentioning

confidence: 99%

Antifungal treatment in haematological and oncological patients: Need for quality assessment in routine care

Lachenmayr

Berking

Horns

et al. 2018

Mycoses

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Invasive fungal infections in haematological and oncological patients have a major impact on morbidity, mortality and treatment costs. Therefore, rational use of antifungal agents is important for optimal patient care and resource use. The study's objective was to analyse antifungal usage in a German tertiary teaching hospital, department of haematology and oncology, to evaluate quality of antifungal treatment and to assess the need for an antifungal stewardship programme. This retrospective observational study included patients ≥18 years receiving systemic antifungals for prophylaxis or therapy of invasive fungal infection between January and June 2016. Appropriateness of antifungal prescriptions was evaluated in accordance with guidelines of the German Society of Haematology and Oncology (DGHO) and drug labelling. In total, 104/1278 (8.1%) patients received antifungals. One hundred seventy-one antifungals were prescribed: 48 for prophylaxis, 104 for empirical and 19 for targeted therapy. In 127 (74.3%) prescriptions, indication was appropriate, and in 132 (77.2%), choice of drug. Antifungals were correctly dosed in 131 prescriptions (76.6%). Thirty-four antifungals (20.0%) were co-administrated with interacting drugs (5 mild to moderate, 29 severe interactions). Results of this analysis demonstrate that use of systemic antifungals in routine care differs in a substantial number of patients from guideline and labelling recommendations. To optimise antifungal use, the implementation of antifungal stewardship programmes seems to be justified.

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Inappropriate Use of Antifungal Medications in a Tertiary Care Center in Thailand: A Prospective Study

Cited by 36 publications

References 9 publications

Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey

Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey

Antifungal stewardship in daily practice and health economic implications

Antifungal treatment in haematological and oncological patients: Need for quality assessment in routine care

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