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Med Mal Infect ; 47(6): 382-388, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28412043

ABSTRACT

OBJECTIVES: To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. METHODS: Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. RESULTS: Seventy-four treatments were analyzed. Treatments were prescribed for prophylactic (1%), empirical (22%), pre-emptive (16%), or targeted therapy (61%). Caspofungin accounted for 68% of prescriptions, followed by voriconazole (20%) and liposomal amphotericin B (12%). Indication was appropriate in 91%, debatable in 1%, and inappropriate in 8%. Dosage was appropriate in 69%, debatable in 8%, and inappropriate in 23%. Prescriptions were inappropriate for the following reasons: lack of dosage adjustment in light of the hepatic function (10 cases), underdosage or excessive dosage by>25% of the recommended dose in seven cases. De-escalation to fluconazole was implemented in 40% of patients presenting with a fluconazole-susceptible candidiasis. CONCLUSION: The overall incidence of appropriate use was higher in 2012 compared with 2007 (62% and 37% respectively, P=0.004). Nevertheless, costly antifungal prescriptions need to be optimized in particular for empirical therapy, dosage adjustment, and potential de-escalation to fluconazole.


Subject(s)
Antifungal Agents/therapeutic use , Mycoses/drug therapy , Adult , Aged , Aged, 80 and over , Amphotericin B/administration & dosage , Amphotericin B/economics , Amphotericin B/therapeutic use , Antifungal Agents/administration & dosage , Antifungal Agents/economics , Caspofungin , Echinocandins/administration & dosage , Echinocandins/economics , Echinocandins/therapeutic use , Female , Hematologic Neoplasms/complications , Hematopoietic Stem Cell Transplantation , Humans , Lipopeptides/administration & dosage , Lipopeptides/economics , Lipopeptides/therapeutic use , Male , Middle Aged , Multiple Organ Failure , Mycoses/complications , Mycoses/mortality , Mycoses/prevention & control , Organ Transplantation , Retrospective Studies , Survival Rate , Treatment Outcome , Voriconazole/administration & dosage , Voriconazole/economics , Voriconazole/therapeutic use , Young Adult
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