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Improving quality of antifungal use through antifungal stewardship interventions

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Abstract

Purpose

In recent years antifungal stewardship (AFS) programmes have been increasingly recommended to provide optimal antifungal treatment. In a previous study (study I) in the department of haematology and oncology of a German tertiary care hospital we found areas for improvement concerning antifungal prescription. Subsequently, AFS measures were implemented and their impact on quality of antifungal use was assessed in this study.

Methods

AFS measures included medical training (two sessions), a pocket card summarising main recommendations for antifungal use, and daily pharmaceutical counselling on the ward. In a 6-month observational study, antifungal prescriptions were analysed and compared to the previously collected data (study I) concerning indication, choice of drug, dosing, duration and drug–drug interactions. The study was approved by the university hospital ethical review board.

Results

Antifungal agents were prescribed for 103/1169 inpatients. Compared to study I, a significant increase in dosage accuracy (+ 19.3%; p < 0.05) and correct choice of drug (+ 15.9%; p < 0.05) was noted, as well as a decrease in potential clinically relevant drug–drug interactions with concomitant medication (− 13.9%; p < 0.05). However, no significant improvement in indication and duration of antifungal treatment was identified. 56 recommendations were given to the prescribing physicians (acceptance rate: 66.1%).

Conclusions

The implementation of AFS interventions based on pharmaceutical presence on the ward was associated with an improvement in antifungal use; however, indication and duration of therapy need to be communicated by infectious disease specialists. Considering the proportionally short observation period, the long-term effects of our AFS interventions need to be further investigated.

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Acknowledgements

This work was supported by the interprofessional PhD-programme Clinical Pharmacy, LMU Munich.

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Author notes

  1. Lachenmayr Sarah Julia and Strobach Dorothea contributed equally to the manuscript.

Authors and Affiliations

  1. Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Sarah Julia Lachenmayr & Dorothea Strobach

  2. Department of Haematology/Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Sophie Berking, Heidi Horns, Karin Berger & Helmut Ostermann

Authors
  1. Sarah Julia Lachenmayr
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  2. Dorothea Strobach
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  3. Sophie Berking
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  4. Heidi Horns
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  5. Karin Berger
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  6. Helmut Ostermann
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Corresponding authors

Correspondence to Sarah Julia Lachenmayr or Helmut Ostermann.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Lachenmayr, S.J., Strobach, D., Berking, S. et al. Improving quality of antifungal use through antifungal stewardship interventions. Infection 47, 603–610 (2019). https://doi.org/10.1007/s15010-019-01288-4

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  • DOI: https://doi.org/10.1007/s15010-019-01288-4

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