Descriptive analysis of guidelines on the use of antifungals in life-limiting disease (17–30)
| Number of guidelines | Antifungal agents mentioned | % High cost* | |
|---|---|---|---|
| Confirmed infection | |||
| Aspergillosis | 9 | Liposomal amphotericin B (7), voriconazole (9), posaconazole (1), caspofungin (1) | 100 |
| Candidosis—haematology | 4 | Liposomal amphotericin B (2), caspofungin (3), micafungin (1), fluconazole (1)† | 71 |
| Candidosis—non-haematology | 2 | Liposomal amphotericin B (2), caspofungin (1), micafungin (1), fluconazole (1)† | 60 |
| Empiric treatment | |||
| 1st line—haematology | 8 | Liposomal amphotericin B (4), voriconazole (3), amphotericin B lipid complex (1) | 88 |
| 2nd line—haematology | Caspofungin (4), voriconazole (2), liposomal amphotericin B (1), micafungin (1) | 88 | |
| 3rd line—haematology | Liposomal amphotericin B (1) | ||
| Intensive care | 1 | Liposomal amphotericin B (1), micafungin (1), fluconazole (1) | |
| Prophylaxis | |||
| Haematology | 11 | Posaconazole (7), itraconazole (4), liposomal amphotericin B (4), voriconazole (2), fluconazole (1) | 72 |
*Assumes micafungin is not a high-cost drug although it was regarded by the National Health Service as a high-cost drug in the first half of the study period.
†In one guideline, use of fluconazole is an additional option if the organism is found to be fluconazole sensitive and neutrophils are increasing.