香港某地区医院全身性抗真菌处方的模式与合理性
The Patterns and Appropriateness of Systemic Antifungal Prescriptions in a Regional Hospital in Hong Kong.
作者信息
Leung Ryan Y H, Lam Jimmy Y W
机构信息
Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
出版信息
Antibiotics (Basel). 2025 May 29;14(6):556. doi: 10.3390/antibiotics14060556.
INTRODUCTION
The consumption of systemic antifungals is on the rise. However, a significant proportion of systemic antifungal prescriptions is inappropriate. Inappropriately prescribed antifungals are problematic, but there has been minimal emphasis on ensuring the appropriate prescription of systemic antifungals. Local studies regarding the patterns and appropriateness of antifungal prescriptions are also lacking.
MATERIALS AND METHODS
In this retrospective, single-centre, observational study, every in-patient prescription order of systemic antifungals in a regional hospital in Hong Kong between 1 May and 31 July 2023 was reviewed via electronic patient records. The appropriateness of a systemic antifungal prescription was assessed by its indication, dosage, duration and antifungal-concomitant drug interactions by a single reviewer.
RESULTS
A total of 177 prescriptions orders were collected. Itraconazole, micafungin and fluconazole were the most prescribed systemic antifungals. The haematology team, infectious disease team and ICU were the major systemic antifungal prescribers in this study. The overall appropriateness of systemic antifungal prescriptions was 27.7% (49/177), with an appropriateness of 72.9% (129/177) for indications, 57.1% (101/177) for dosage, 91.5% (162/177) for duration and 71.6% (127/177) for antifungal-concomitant drug interactions. Triazole antifungals had an overall prescription appropriateness of only 15% and were more likely to be prescribed inappropriately than non-triazole antifungals ( < 0.001). Common prescription pitfalls include (i) starting a systemic antifungal for sputum culture that grew spp., (ii) debatable prophylaxis with itraconazole capsules, (iii) overlooking potentially serious antifungal-drug interactions.
CONCLUSIONS
Inappropriate systemic antifungal prescription is not uncommon in Hong Kong. Establishing an antifungal stewardship programme in public hospitals may be beneficial.
引言
全身性抗真菌药物的使用量正在上升。然而，相当一部分全身性抗真菌药物的处方并不恰当。不合理开具的抗真菌药物存在问题，但在确保全身性抗真菌药物的合理处方方面，人们的重视程度一直很低。关于抗真菌药物处方模式和合理性的本地研究也很缺乏。
材料与方法
在这项回顾性、单中心观察性研究中，通过电子病历对香港一家地区医院在2023年5月1日至7月31日期间开具的每一份全身性抗真菌药物住院处方进行了审查。由一名评审员根据适应证、剂量、疗程以及抗真菌药物与其他药物的相互作用来评估全身性抗真菌药物处方的合理性。
结果
共收集到177份处方。伊曲康唑、米卡芬净和氟康唑是开具最多的全身性抗真菌药物。血液科团队、感染病团队和重症监护病房是本研究中主要的全身性抗真菌药物开具科室。全身性抗真菌药物处方的总体合理性为27.7%（49/177），其中适应证的合理性为72.9%（129/177），剂量的合理性为57.1%（101/177），疗程的合理性为91.5%（162/177），抗真菌药物与其他药物相互作用的合理性为71.6%（127/177）。三唑类抗真菌药物的总体处方合理性仅为15%，且比非三唑类抗真菌药物更易被不合理开具（<0.001）。常见的处方陷阱包括：（i）针对培养出 菌属的痰标本开始使用全身性抗真菌药物；（ii）使用伊曲康唑胶囊进行有争议的预防；（iii）忽视潜在的严重抗真菌药物相互作用。
结论
在香港，不恰当的全身性抗真菌药物处方并不罕见。在公立医院建立抗真菌药物管理计划可能会有所帮助。
Zotero 插件