Antifungal drugs are a valuable resource, but since many years, they have been used excessively and the cost is not negligible. There is an urgent need to change prescribing practice. We analyze antifungal use in four different moments during two years in a Belgian university hospital with the aim of improving antifungal stewardship.
Four point prevalence surveys (PPS) were undertaken prospectively during February 2014, March 2014, August 2014 and March 2015. The quality of treatments was assessed by an infectious disease specialist and two pharmacists according to standard guidelines. The percentage agreement with indication, dosage and duration of treatment was determined using an adaptation for antifungal drug use of a standardized method for antimicrobial drug use evaluation, developed by Gyssens et al1.
One hundred and two antifungal therapies were prescribed to ninety-eight patients during the four PPS. Fluconazole was the drug most frequently used (61,76%), followed by voriconazole (13,73%). Indications were considered correct in all cases, but in 7.84% of cases the antifungal drug was not chosen correctly On average, 4,90% of patients were prescribed higher doses of antifungal drugs than usual, whereas 5,88% of patients received lower doses. The evaluation revealed least agreement with the dosage in cases of oral candidiasis treatment. Loading dose was not given in four treatments (3,92%) in which it was required. Switch to oral therapy was considered correct in all cases when it could be practiced. In general, expert reviewers agreed with 78,43% of prescriptions. Potential interactions took place in 67,65% of prescriptions. The four pps showed an increase in use of antifungal drugs over time. 87,25% of prescription were considered to have a correct duration.
The four PPS identified antifungal use problems that should be improved by education and feedback of these results of prescribing habits. This kind of interventions is one of the most successful means of influencing physicians' performance.
1 Gyssens et al, Int J Antimicrob Agents, 2001
B. Vandercam, None
C. Briquet, None
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