Article

European Journal of Clinical Microbiology & Infectious Diseases

, Volume 31, Issue 3, pp 337-347

First online:

Use of antifungal agents in pediatric and adult high-risk areas

  • E. RamírezAffiliated withClinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid Email author 
  • , J. García-RodríguezAffiliated withMicrobiology Service, Hospital Universitario La Paz, IdiPAZ
  • , A. M. BorobiaAffiliated withClinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid
  • , J. M. OrtegaAffiliated withPharmacy Service, Hospital Universitario La Paz, IdiPAZ
  • , S. LeiAffiliated withClinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid
  • , A. Barrios-FernándezAffiliated withMicrobiology Service, Hospital Universitario La Paz, IdiPAZ
  • , M. SánchezAffiliated withPharmacy Service, Hospital Universitario La Paz, IdiPAZ
  • , A. J. CarcasAffiliated withClinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid
  • , A. HerreroAffiliated withPharmacy Service, Hospital Universitario La Paz, IdiPAZ
    • , J. M. de la PuenteAffiliated withMedical Subdirection, Hospital Universitario La Paz, IdiPAZ
    • , J. FríasAffiliated withClinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid

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Abstract

The purpose of this investigation was to describe the characteristics of the use of systemic antifungal agents (AFAs) and to evaluate their appropriateness of use. A prospective drug-utilisation study was conducted in intensive-care areas: haematology-oncology services and transplant units. Data were collected in three periods over 9 months. The required sample size was determined to be 113 patients (margin of error ±7%, 95% confidence interval [CI]), assuming a variability of 50%. Two different investigator groups evaluated the appropriateness of use separately; Cohen’s Kappa index was used to calculate the degree of agreement between groups. A total of 114 patients we included, of which 62 (54.4%) were children. A total of 150 prescriptions were administered; fluconazole was the most frequently prescribed (38%), followed by liposomal amphotericin B (22.7%) and caspofungin (18.7%). The indications were: (1) pre-emptive treatment of Candida in non-neutropaenic critically ill patients (35.1%), (2) treatment of systemic fungal infection (24.6%), (3) prophylaxis for systemic fungal infection (SFI) in immunocompromised patients (16.7%), (4) prophylaxis of SFI in transplant recipients (12.3%), (5) prophylaxis of SFI in preterm infants (5.3%), (6) treatment of SFI in neonates (6.1%). The Kappa index showed a substantial agreement (Kappa = 0.73). The indications were considered to be inappropriate in 71 (47.3%) episodes. The indications or dosages were inappropriate in 79 cases (52.7%). The indications, dosages or duration of treatment were inappropriate in 83 cases (55.3%). We conclude that AFAs are prescribed for a significant number of inappropriate indications.