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. 2024 Nov 13;10(11):787.
doi: 10.3390/jof10110787.

The Effects of COVID-19 on Antifungal Prescribing in the UK-Lessons to Learn

Katharine Pates  1 , Zhendan Shang  2 , Rebeka Jabbar  3 , Darius Armstrong-James  4   5 , Silke Schelenz  6 , Jimstan Periselneris  1 , Rossella Arcucci  7 , Anand Shah  5   8
Affiliations

The Effects of COVID-19 on Antifungal Prescribing in the UK-Lessons to Learn

Katharine Pates et al. J Fungi (Basel). .

Abstract

Fungal infections are increasingly prevalent; however, antifungal stewardship attracts little funding or attention. Previous studies have shown that knowledge of guidelines and scientific evidence regarding antifungals is poor, leading to prescribing based on personal experiences and the inherent biases this entails. We carried out a retrospective study of inpatient antifungal usage at two major hospitals. We assessed the longitudinal trends in antifungal usage and the effect of COVID-19 on antifungal prescription, alongside levels of empirical and diagnostically targeted antifungal usage. Our results showed that the longitudinal patterns of total systemic antifungal usage within the trusts were similar to national prescribing trends; however, the composition of antifungals varied considerably, even when looking exclusively at the more homogenous group of COVID-19 patients. We showed a high level of empirical antifungal use in COVID-19 patients, with neither trust adhering to international recommendations and instead appearing to follow prior prescribing habits. This study highlights the significant challenges to optimise antifungal use with prescribing behaviour largely dictated by habit, a lack of adherence to guidelines, and high rates of empirical non-diagnostic-based prescribing. Further research and resources are required to understand the impact of antifungal stewardship on improving antifungal prescribing behaviours in this setting and the effects on outcome.

Keywords: COVID-19; antifungal; stewardship.

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Conflict of interest statement

A.S. has received research funding from Pfizer and Gilead sciences and consulting and speaker fees from Pfizer, Gilead, Astra Zeneca, and Multipharma. J.P. and S.S. have received educational honoraria from Pfizer and Gilead. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
(A) Total systemic antifungal usage at KCH between January 2015 and December 2021. (B) Total systemic antifungal usage at RBH between January 2015 and December 2021.
Figure 2
Figure 2
(A) Total systemic antifungal usage in the intensive care unit at KCH between January 2015 and December 2021. (B) Total systemic antifungal usage in the intensive care unit at RBH between January 2015 and December 2021.
Figure 3
Figure 3
(A) Antifungal usage in patients with confirmed or suspected COVID-19 at KCH. (B) Antifungal usage in patients with confirmed or suspected COVID-19 at RBH.
Figure 4
Figure 4
Number of azole-resistant Aspergillus species identified at RBH between 2015 and 2021.
See this image and copyright information in PMC

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