Background Viral infections are extremely common and often a severe complication of bone marrow transplantation. In particular, cytomegalovirus (CMV) infection is considered a major cause of morbidity and mortality1 in transplant recipients. This can partly justify the increased consumption of antivirals, most of which are expensive molecules with a significant budgetary share.
Purpose Evaluation of the relevance of systemic antiviral prescriptions as per our internal protocol according to international guidelines.2
Material and methods This was a retrospective study, carried in the haematology and transplantation department, which reviewed the appropriateness of treatment targeting 136 systemic antiviral prescriptions to prevent or treat CMV infection, from 2009 to 2014. This study included 48 patients who had at least one reactivation of CMV during the period of analysis. The evaluation tool used was the index of therapeutic adequacy (ITA): it is a score whose calculation methods are defined in the table.
If the indication of the antiviral conformed or was disputed, we evaluated the six secondary criteria as defined in accordance with international guidelines. At the end of the evaluation, we calculated the index by adding the scores obtained for each of the seven criteria. A prescription considered fully compliant over the ITA will be low and for those conforming less over the ITA will be higher.
Results The results showed that 68% (92 of 136 antiviral prescriptions) of prescriptions were deemed fully compliant with the guidelines for the indication (primary endpoint) and all administrative modalities (secondary endpoints). Non-conformities resided in the choice of molecule, dosage and route of administration with a rate equal to 2.2%, as well as for the criteria of duration of treatment and the combination of antivirals with, respectively, a rate of non-conformities of 3.7% and 4.5%.
Conclusion The non-conformities identified during this work allowed us to define the priorities that will be the starting point of a quality approach to improve antiviral prescriptions.
References and/or acknowledgements
Segondy M. Infections virales chez les patients transplantés. 2008 June 27. http://www.em-consulte.com/en/article/17608
Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among haematopoietic cell transplantation recipients: A global perspective. Biol Blood Marrow Transplant2009;15:1143–238.
References and/or acknowledgementsNo conflict of interest
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