Background Invasive fungal infections (IFI) have a substantial morbidity and mortality, and their incidence has steadily increased over the past 20 years due to the increase in immunocompromised patients. The complex medical care, the expensive treatments and the emergence of antifungal resistance require appropriate prescribing.
Purpose The aim of this study was to assess the conformity of antifungal prescribing to local and international guidelines for the treatment of IFI in a teaching hospital and to compare with similar studies.
Material and methods Prospective study was performed in six wards (paediatric oncology, haematology and intensive care units) that accounted for 90% of the antifungal consumption at our facility. The study was performed between April and May of 2018. A multidisciplinary group produced a grid for prescription compliance in accordance with the local and international guidelines from the European Conference on Infections Leukaemia and the Infectious Diseases Society of America. The prescriptions were reviewed by two pharmacists.
Results Eighty-seven prescriptions were analysed for 79 patients. Treatments were prescribed for prophylaxis (n=29), empirical therapy (n=22), pre-emptive therapy (n=14) and targeted therapy (n=22). On average, the patients had three risk factors for IFI and 21 patients (24.1%) were deceased. The antifungal treatments were in keeping with the local guidelines for 63 prescriptions (72.4%) and with the international guidelines for 57 prescriptions (65.5%). The guidelines issued within the facility closely follow these international guidelines. The most common inappropriate use was an antifungal prescription of second- or third-line while the first-line antifungal therapy was an option (14.9%), typically by an azole. Another cause of misuse was the non-compliance with antifungal prophylaxis indications (9.2%), leading to unnecessary exposure to antifungal agents.
Conclusion Few studies to date have assessed the appropriate use of antifungals. In the studies published to date with a similar methodology, compliance with the international guidelines has been reported to be between 34%1 and 58%2. A multidisciplinary antifungal group was implemented to curb IFI and to improve the use of antifungals. In this context, guidelines were updated in the form of decision algorithms that, once adopted as a guide, should be able to improve practices.3
References and/or acknowledgements 1. https://academic.oup.com/jac/article/67/10/2506/727074
No conflict of interest.