Hospital use of systemic antifungal drugs

Abstract

Background: Sales data indicate a major increase in the prescription of antifungal drugs in the last two decades. Many new agents for systemic use that only recently have become available are likely to be prescribed intensively in acute care hospitals. Sales data do not adequately describe the developments of drug use density. Given the concerns about the potential emergence of antifungal drug resistance, data on drug use density, however, may be valuable and are needed for analyses of the relationship between drug use and antifungal resistance.

Methods: Hospital pharmacy records for the years 2001 to 2003 were evaluated, and the number of prescribed daily doses (PDD, defined according to locally used doses) per 100 patient days were calculated to compare systemic antifungal drug use density in different medical and surgical service areas between five state university hospitals.

Results: The 3-year averages in recent antifungal drug use for the five hospitals ranged between 8.6 and 29.3 PDD/100 patient days in the medical services (including subspecialties and intensive care), and between 1.1 and 4.0 PDD/100 patient days in the surgical services, respectively. In all five hospitals, systemic antifungal drug use was higher in the hematology-oncology service areas (mean, 48.4, range, 24 to 101 PDD/100 patient days, data for the year 2003) than in the medical intensive care units (mean, 18.3, range, 10 to 33 PDD/100) or in the surgical intensive care units (mean, 10.7, range, 6 to 18 PDD/100). Fluconazole was the most prescribed antifungal drug in all areas. In 2003, amphotericin B consumption had declined to 3 PDD/100 in the hematology-oncology areas while voriconazole use had increased to 10 PDD/100 in 2003.

Conclusion: Hematology-oncology services are intense antifungal drug prescribing areas. Fluconazole and other azol antifungal drugs are the most prescribed drugs in all patient care areas while amphotericin B use has considerably decreased. The data may be useful as a benchmark for focused interventions to improve prescribing quality.

Figure 1

Yearly systemic antifungal drug use density in the medical and surgical services of five university hospitals (A through E) for the years 2001–2002–2003.

Figure 2

Use density for different antifungal drugs in the medical service of five university hospitals. Data are yearly means for 2001, 2002 and 2003. cAmB, conventional amphotericin B; L-AmB, liposomal amphotericin B; Caspo, caspofungin; Fluco, fluconazole; Itra, itraconazole; Vori, voriconazole.

Figure 3

Use of fluconazole (grey bars) versus other systemic antifungal drugs (black bars) in the SICU, MICU, and in the hematology-oncology services of five university hospitals (A through E) during the years 2001–2002–2003.