ABSTRACT
Background and importance Isavuconazole is a new antifungal triazole authorised for invasive aspergillosis and mucormycosis. It is a therapeutic alternative to voriconazole and liposomal amphotericin B for invasive aspergillosis, and to liposomal amphotericin B in mucormycosis. Aim and objectives To analyse prescription characteristics of isavuconazole in patients with COVID-19 in an intensive care unit (ICU) as well as its effectiveness and safety. Material and methods A cross-sectional, observational study was conducted (June 2020-April 2021). Patients with COVID-19 in an ICU on treatment with isavuconazole were included. Electronic prescription program and clinical history were used to collect the following data: sex, age, comorbidities, coinfection with other pathogens in addition to SARS-CoV-2, type of therapy (empirical/targeted), duration and previous azole treatment (yes/no). Effectiveness was evaluated by symptoms resolution, reasons for treatment suspension and status (alive/death) 30 days after completion of treatment. Safety was assessed according to adverse events (AE). Results Thirty-three patients (54.5% men) with mean age of 61 (35-77) years were evaluated. Twenty-nine patients (87.9%) had comorbidities, the most frequent were: hypertension (19.1%), dyslipidaemia (12.8%), obesity (11.7%) and diabetes (8.5%). Thirty-two (96.9%) had coinfections, with a mean of 1.8 (SD 1.2) infections/patient. The most implicated pathogens were: Acinetobacter baumanii (18.8%), Candida albicans (11.6%) and Aspergillus fumigatus (8.7%). Twentythree patients (69.7%) received isavuconazole as empirical therapy and 10 (30.3%) as targeted. Mean duration of treatment was 12.3 (SD 7.5) days. Twenty-five (75.6%) patients had not previously received azole treatment, 7 (21.3%) had received voriconazole and 1 (3%) fluconazole. Symptoms resolution was observed in 12 (36.4%) cases. Seven patients (21.2%) discontinued treatment due to negative culture, 12 (36.4%) due to symptoms resolution and 14 (42.4%) due to death. At 30 days completion of treatment, 15 patients (45.5%) remained alive and 18 (54.5%) had died. AE were recorded in 6 cases (18.2%): liver disorders (n=4) and electrolytic alterations (n=2). Conclusion and relevance Most patients presented comorbidities and coinfections in addition to COVID-19. Effectiveness of isavuconazol was adequate in approximately one-third of patients, despite the high severity and clinical complexity. Approximately half the patients remained alive at 30 days following completion of treatment. Isavuconazol was well tolerated in most cases.
ABSTRACT
Background and importanceThe SARS-CoV-2 pandemic has generated new needs in outpatient care of the hospital pharmacy. Despite the current improvement in the pandemic situation, many of the implemented progress have been maintained. Telepharmacy and home delivery programmes avoid hospital visits for vulnerable patients (elderly, pluripathology, mobility problems).Aim and objectivesTo analyse the degree of satisfaction of patients included in a telepharmacy and home delivery programme.Material and methodsDescriptive retrospective study of patients included in a telepharmacy and home delivery programme between November 2020 and September 2021 was conducted. Electronic clinical history and prescription software Farmatools were used to record data: sex, age, pathology, locality, transport conditions of the medication and number of shipments per patient. A telephone survey was conducted, consisting of four questions about: satisfaction with telepharmacy programme (yes/no), adequate pharmaceutical telephone support (yes/no), medication delivery conditions (correct/incorrect) and global assessment (ranged 1–10). Comments and suggestions were also requested.ResultsFifty-six patients were included, 35 (63%) were women and 21 (37%) men. Mean age was 65 (37–90) years. The pathologies involved were: 11 (20%) infectious diseases, 10 (18%) respiratory, 9 (16%) rheumatic, 8 (14%) neurological, 7 (12%) renal, 5 (9%) haematological, 3 (5%) ophthalmological, 2 (4%) digestive and 1 (2%) allergic. A total of 456 medication shipments were delivered during the study period, with a mean of 8 (2–24) per patient. The shipments were distributed among 31 different localities in the same health area. The medication for 27 (48%) patients required refrigerated transport, and 29 (52%) required ambient temperature. All (100%) patients were satisfied with telepharmacy programme and reported an adequate pharmaceutical telephone support. Medication delivery conditions were considered correct to 54 (96%) patients and incorrect to 2 (4%). Mean global assessment score was 9.6 (8–10). Four (7%) patients suggested an improvement in delivery conditions.Conclusion and relevanceThe survey results indicated a high degree of satisfaction of the patients included in the telepharmacy and home delivery programme. Although this system of pharmaceutical care and distribution of medicines was implemented because of the pandemic, its subsequent maintenance has allowed vulnerable patients to benefit. Further measures could be implemented to improve delivery conditions.References and/or acknowledgementsConflict of interestNo conflict of interest