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

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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.

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Acknowledgements

None to declare.

Funding

The study was carried out as part of the routine work of the Pharmacy Commission of the Hospital Universitario La Paz.

Conflicts of interest

Dr. Julio García-Rodríguez has been an advisor for Gilead Sciences, has received grant support from Gilead Sciences and Pfizer, has received travel grants from Merck Sharp & Dohme (MSD), Gilead Sciences, Pfizer and Astellas, and has served as a speaker to Pfizer, MSD and Astellas.

All other authors: none to declare.

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Authors and Affiliations

  1. Clinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of Medicine, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029, Madrid, Spain

    E. Ramírez, A. M. Borobia, S. Lei, A. J. Carcas & J. Frías

  2. Microbiology Service, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain

    J. García-Rodríguez & A. Barrios-Fernández

  3. Pharmacy Service, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain

    J. M. Ortega, M. Sánchez & A. Herrero

  4. Medical Subdirection, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain

    J. M. de la Puente

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  1. E. Ramírez
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Ramírez, E., García-Rodríguez, J., Borobia, A.M. et al. Use of antifungal agents in pediatric and adult high-risk areas. Eur J Clin Microbiol Infect Dis 31, 337–347 (2012). https://doi.org/10.1007/s10096-011-1315-x

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