Akbar Zunaira, Aamir Muhammad, Saleem Zikria
Department of Pharmacy, The University of Lahore, Lahore, Pakistan.
Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore, Pakistan.
Front Med (Lausanne). 2024 Dec 3;11:1489109. doi: 10.3389/fmed.2024.1489109. eCollection 2024.
Specific evidence regarding the pharmacist's role in antifungal stewardship (AFS) is emerging. This review aims to identify pharmacist-driven AFS interventions to optimize antifungal therapy.
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data (2018-2023) were collected through Google Scholar and PubMed. The collected data were presented descriptively due to variations in interventions and outcome metrics. Conclusions were derived through a qualitative synthesis of the identified findings.
A total of 232 articles were retrieved, and after applying inclusion and exclusion criteria, 27 were included in the review. Among the eight studies evaluating the impact of pharmacist interventions on antifungal consumption, 6 studies reported a significant decline in defined daily dose (DDD)/1,000 patient days and days of therapy (DOT)/1,000 patient days, one reported a non-significant decrease, and one reported an increase in the utilization of echinocandins. Educational intervention was the most commonly used stewardship approach. Nineteen studies reported data on various clinical outcomes. Mortality and length of hospital stay remain non-significant, but the occurrence of ADR decreased significantly, and the quality of antifungal use improved significantly.
Pharmacist-led AFS has the potential to enhance the effectiveness of antifungal treatments by improving their overall quality, reduction in consumption, and adverse events. The healthcare system should encourage multidisciplinary collaboration where pharmacists play a central role in decision-making processes regarding antifungal use.
关于药剂师在抗真菌管理（AFS）中作用的具体证据正在不断涌现。本综述旨在确定由药剂师推动的AFS干预措施，以优化抗真菌治疗。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。通过谷歌学术和PubMed收集2018年至2023年的数据。由于干预措施和结果指标存在差异，对收集到的数据进行描述性呈现。通过对已确定研究结果的定性综合得出结论。
共检索到232篇文章，应用纳入和排除标准后，27篇被纳入综述。在八项评估药剂师干预对抗真菌药物使用影响的研究中，六项研究报告限定日剂量（DDD）/每1000患者日和治疗天数（DOT）/每1000患者日显著下降，一项报告下降不显著，一项报告棘白菌素的使用增加。教育干预是最常用的管理方法。19项研究报告了各种临床结果的数据。死亡率和住院时间仍无显著变化，但药物不良反应的发生率显著下降，抗真菌药物使用质量显著提高。
由药剂师主导的AFS有潜力通过提高抗真菌治疗的整体质量、减少药物消耗和不良事件来增强其有效性。医疗保健系统应鼓励多学科合作，让药剂师在抗真菌药物使用的决策过程中发挥核心作用。
