Abstract
Antimicrobial stewardship programs promote excellence in the use of antimicrobials by selecting the appropriate antimicrobial agent and using the correct dose, route of administration and duration of treatment. However, there is limited experience with such programs targeting antifungal treatments. We present the results of a non-compulsory program for the control of antifungals. For 12 months, prescriptions of oral voriconazole or intravenous (IV) voriconazole, caspofungin and liposomal amphotericin B were reviewed and non-compulsory recommendations were made. The incidence and outcome of fungal infections were examined. The results on the dispensed defined daily doses (DDD) and expenses on antifungals were compared to those of the previous 12 months. The number of antifungal treatments reviewed was 662. A recommendation to change treatment was made in 29% of the cases, including a change from IV to oral treatment (15%), a cessation of antifungal treatment (8%) and a change to fluconazole (6%). The DDD of IV voriconazole and caspofungin were reduced by 31.4% and 20.2%, respectively. The DDD of oral voriconazole and dispensed vials of liposomal amphotericin B were increased by 8.2% and 13.9%, respectively. The antifungal expenses were reduced by US$370,681.78 (11.8% reduction). The programme was not related to a significant increase in the incidence of candidemia, percentage of persistent/relapsing candidemia, percentage of resistant to fluconazole Candida species, incidence of infections by filamentous fungi or 12-month mortality in patients with filamentous fungi infections. In conclusion, a stewardship program targeting antifungals achieved a reduction in antifungal expenses without reducing the quality of care provided.
© 2012 The Authors Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases
No comments:
Post a Comment