Hospital use of systemic antifungal drugs: a multi-center surveillance update from Germany

Gross, Barbara N.; Steib-Bauert, Michaela; Kern, Winfried V.; Knoth, Holger; Borde, J; Krebs, Sabine; Hug, Martin; Rothe, Ulrich; Maier, L.

doi:10.1007/s15010-015-0742-5

Cited by 28 publications

(28 citation statements)

References 22 publications

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“…Neoplasms in patients are associated with various clinical factors that require an antifungal prescription, and comorbidities requiring multiple medications predispose patients to drug interactions and ADRs . Considering the widespread use of antifungal agents in clinical practice and that cancer patients are often excluded from clinical trials, the importance of identifying antifungal agents that cause ADRs and drug interactions in these patients is clear .…”

Section: Discussionmentioning

confidence: 99%

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Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High‐Complexity Hospital

Souza

Santos

Reis

2016

The Journal of Clinical Pharma

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The aim of the present study was to determine the frequency of adverse drug reactions (ADRs) associated with the use of systemic antifungal drugs in patients hospitalized at a high-complexity hospital. In addition, factors associated with ADRs were investigated. This cross-sectional retrospective study involved the investigation of 183 medical records of patients receiving systemic antifungal therapy. Antifungal drugs were classified using the fourth level of the Anatomical Therapeutic Chemical System. ADR causality was classified using the Naranjo algorithm. Drug interactions were assessed using DRUG-REAX software. Data were analyzed with descriptive statistics and univariate and multivariate logistic regression. A total of 53 patients (29.0%) had at least 1 ADR involving antifungals. Ninety-six ADRs were detected. The main ADRs observed were an infusion reaction in 24 patients (25.0%), hypokalemia in 22 (22.9%), nephrotoxicity in 18 (18.7%), and hepatotoxicity in 15 (15.6%). Amphotericin B and voriconazole were associated with ADRs of major clinical impact. Eleven of the ADRs (11.4%) were related to drug interactions. The following 3 factors were contributors to the multivariate model for the occurrence of ADRs caused by antifungal drug use: neoplasm diagnosis (odds ratio [OR], 3.9; 1.9-7.9), length of hospital stay (OR, 2.2; 1.1-4.5), and the use of ≥13 drugs (OR, 3.4; 1.6-7.2). Our study revealed positive associations between the occurrence of ADRs and diagnosis of a neoplasm, the length of stay, and the use of multiple drugs concomitant with antifungals. These risk factors should be considered in antifungal stewardship, among other actions, to promote the rational use of antifungal agents.

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Section: Discussionmentioning

confidence: 99%

“…Appropriate use of these novel agents has important implications for patient care and for health care–associated infection control . Inappropriate use of antifungal agents may result in adverse events, unnecessary exposure, higher costs, and increased microbial resistance …”

mentioning

confidence: 99%

Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High‐Complexity Hospital

Souza

Santos

Reis

2016

The Journal of Clinical Pharma

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“…Several studies have found that fluconazole is still the most frequently prescribed antifungal agent despite the market introduction of echinocandins and mold-active azoles. [20][21][22][23] In terms of available benchmarking data, one study examined antifungal utilization between 2001-2003 and 2008-2011 at 5 academic teaching hospitals in Germany. 20 These hospitals were tertiary care referral centers with all major services including HCT, SOT, and level one trauma capabilities.…”

Section: Antifungal Utilization In Adults and Pediatricsmentioning

confidence: 99%

“…[20][21][22][23] In terms of available benchmarking data, one study examined antifungal utilization between 2001-2003 and 2008-2011 at 5 academic teaching hospitals in Germany. 20 These hospitals were tertiary care referral centers with all major services including HCT, SOT, and level one trauma capabilities. Drug use densities were calculated as yearly recommended daily doses (RDD) per 100 patient-days.…”

Section: Antifungal Utilization In Adults and Pediatricsmentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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“…The morbidity of invasive fungal disease (IFD) has increased dramatically in recent years due to high morbidity of malignant tumours, extensive applications of allogeneic haematopoietic stem‐cell transplantation and solid organ transplantation, growing use of immune inhibitors and chemotherapy drugs, and the long‐term use of broad‐spectrum antibiotics . The increasing morbidity of IFD has consequently caused the concomitant application of increasing numbers of antifungal drugs . Azoles, polyenes and echinocandins are the main kinds of antifungal drugs that are applied clinically.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey

Dong

Zhang

et al. 2017

J Clin Pharm Ther

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Contrasted with previous studies that have only focused on a subset of indicators, this research establishes comprehensive indicators for evaluating the use of triazoles for invasive fungal disease and which cover most of the medication process: indications, therapeutic timing, duration of drug usage, drug dosage, administration method, drug interactions, medication in specific populations and pharmaceutical care. The indicators can reflect the characteristic of triazoles throughout the process of clinical administration for an invasive fungal disease, and it will be helpful as references when hospital administrators are regulating the use of antifungals.

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Hospital use of systemic antifungal drugs: a multi-center surveillance update from Germany

Cited by 28 publications

References 22 publications

Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High‐Complexity Hospital

Adverse Drug Reactions in Patients Receiving Systemic Antifungal Therapy at a High‐Complexity Hospital

Antifungal stewardship considerations for adults and pediatrics

Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey

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