Pharmacy, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
J Antimicrob Chemother. 2012 Oct;67(10):2506-13. doi: 10.1093/jac/dks256. Epub 2012 Jul 9.
The aim of our study was to assess the adherence to labelling and international guidelines for antifungal prescribing.
A retrospective study was performed in intensive care units in addition to the oncology and haematology department, which covered 70% of antifungal consumption at Hautepierre Hospital, Strasbourg, France. On reviewing medical charts, the antifungal prescription was examined in relation to the recommendations of indication, dosage, risk of drug-drug interactions and, where appropriate, antifungal susceptibility testing. Treatments were considered appropriate, inappropriate or debatable.
Between January and April 2007, 199 treatments were given for 179 different episodes in 133 adult patients. Treatments were prescribed for pre-emptive or targeted therapy (n = 90, with 60 for candidiasis, 26 for aspergillosis and 4 for other mould diseases), empirical therapy (n = 17) and primary (n = 81) or secondary (n = 11) prophylaxis. Fluconazole accounted for 67% of prescriptions, followed by voriconazole (19%), caspofungin (10%), posaconazole (2%), conventional or liposomal amphotericin B (2%), itraconazole (<1%) and terbinafine (<1%). Indication and dosage were found to be appropriate in 65% and 62% of cases, inappropriate in 22% and 21%, and debatable in 13% and 17%, respectively. The overall (by combining all assessment criteria) rate of inappropriate use was 40%. The overall survival rate at 12 weeks was highest in patients receiving appropriate therapy (81% versus 72% and 68% in the debatable and inappropriate therapy groups, respectively), with between-group differences not being significant (P = 0.49).
Our evaluation revealed a high proportion of inappropriate or debatable use of antifungal agents, while highlighting significant issues, such as inadequate dosage or indications.
本研究旨在评估抗真菌药物标签和国际指南的遵循情况。
在法国斯特拉斯堡 Hautepierre 医院的重症监护病房、肿瘤学和血液科进行了一项回顾性研究，该研究涵盖了 70%的抗真菌药物消耗。在审查病历时，根据适应证、剂量、药物相互作用风险以及在适当情况下抗真菌药敏试验的建议，检查抗真菌药物处方。治疗被认为是适当的、不适当的或有争议的。
2007 年 1 月至 4 月，133 名成年患者共发生 179 例不同的真菌感染，给予 199 种治疗。治疗方案包括预防或靶向治疗（n=90，其中 60 例用于念珠菌病，26 例用于曲霉病，4 例用于其他霉菌病）、经验性治疗（n=17）、一级（n=81）或二级（n=11）预防。氟康唑占处方的 67%，其次是伏立康唑（19%）、卡泊芬净（10%）、泊沙康唑（2%）、普通或脂质体两性霉素 B（2%）、伊曲康唑（<1%）和特比萘芬（<1%）。适应证和剂量在 65%和 62%的病例中被认为是适当的，在 22%和 21%的病例中是不适当的，在 13%和 17%的病例中是有争议的。总体（通过结合所有评估标准）不适当使用的比率为 40%。在 12 周时，接受适当治疗的患者的总体生存率最高（分别为 81%、72%和 68%，在有争议和不适当治疗组中），但组间差异无统计学意义（P=0.49）。
我们的评估显示，抗真菌药物的不适当或有争议使用比例较高，同时突出了剂量或适应证不足等重大问题。
