El-Hussain Fatima Issa, Balkhair Abdullah, Al-Zakwani Ibrahim, Al Za'abi Mohammed
MSc. Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
MD. FRCPc. Senior Consultant, Infectious Diseases Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Pharm Pract (Granada). 2022 Jan-Mar;20(1):2613. doi: 10.18549/PharmPract.2022.1.2613. Epub 2022 Jan 20.
The inappropriate use of antimicrobials has substantially contributed to the development of antimicrobial drug resistance. Appropriate antibacterial prescribing has been emphasised, with minimal focus on appropriate prescribing of antifungals. Evaluation of antifungal use in the clinical setting is essential to prevent unnecessary drug exposure, development of resistance, adverse effects, and high hospitalisation costs.
The purpose of this study was to assess the appropriateness of antifungal prescribing among adult patients at the Sultan Qaboos University Hospital (SQUH) in Oman.
In this retrospective, observational study, the study population comprised adult patients treated with oral or intravenous antifungals between July 2018 and December 2019. The appropriateness of treatment was assessed using guidelines from the Infectious Diseases Society of America (IDSA) and the National Comprehensive Cancer Network (NCCN), as well as a set of literature-based criteria that were modified by SQUH infectious diseases team to suit local practices. These criteria included indication, dosage, and potential drug interactions. The primary outcome was the frequency of adherence to the treatment guidelines for fungal infections. Descriptive statistics were used for data analysis.
A total of 400 prescriptions were collected, of which 158 (39.5%) were for empirical therapy, 135 (33.8%) for targeted therapy, 69 (17.3%) for prophylactic therapy, and 38 (9.5%) for pre-emptive therapy. The overall appropriateness was 74.8%. The indication, dosage, and potential for antifungal-drug interactions were considered appropriate in 391 (97.8%), 314 (78.5%), and 381 (95.3%) prescriptions, respectively. Anidulafungin was the most prescribed antifungal agent, with 210 prescriptions (52.5%), followed by fluconazole with 102 prescriptions (25.5%), and voriconazole with 48 prescriptions (12%).
In comparison with publised literature, our study revealed appropriate antifungal drug prescribing practices. However, studies with larger sample size in various hospital settings are necessary to confirm our findings on a national scale, and to obtain better statistical inferences and generalisability.
抗菌药物的不当使用在很大程度上导致了抗菌药物耐药性的产生。人们一直强调合理使用抗菌药物，而对合理使用抗真菌药物的关注却很少。评估临床环境中的抗真菌药物使用情况对于防止不必要的药物暴露、耐药性的产生、不良反应以及高昂的住院费用至关重要。
本研究的目的是评估阿曼苏丹卡布斯大学医院（SQUH）成年患者抗真菌药物处方的合理性。
在这项回顾性观察研究中，研究人群包括2018年7月至2019年12月期间接受口服或静脉注射抗真菌药物治疗的成年患者。使用美国传染病学会（IDSA）和美国国立综合癌症网络（NCCN）的指南以及SQUH传染病团队根据文献修改以适应当地实践的一组标准来评估治疗的合理性。这些标准包括适应症、剂量和潜在的药物相互作用。主要结果是符合真菌感染治疗指南的频率。采用描述性统计方法进行数据分析。
共收集到400份处方，其中158份（39.5%）为经验性治疗，135份（33.8%）为靶向治疗，69份（17.3%）为预防性治疗，38份（9.5%）为抢先治疗。总体合理性为74.8%。在391份（97.8%）、314份（78.5%）和381份（95.3%）处方中，抗真菌药物的适应症、剂量和潜在相互作用分别被认为是合适的。阿尼芬净是处方最多的抗真菌药物，有210份处方（52.5%），其次是氟康唑，有102份处方（25.5%），伏立康唑有48份处方（12%）。
与已发表的文献相比，我们的研究揭示了合理的抗真菌药物处方做法。然而，需要在不同医院环境中进行更大样本量的研究，以在全国范围内证实我们的发现，并获得更好的统计推断和普遍性。
