antifungal stewardship in a tertiary care paediatric hospital the proafungi study
Copyright policy )antifungal stewardship in a tertiary care paediatric hospital the proafungi study
Abstract Background The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. Methods Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July–October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. Results The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4–13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. Conclusions A high rate of AF appropriateness was found for the children’s hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children.
Male, Antifungal Agents, Adolescent, :Therapeutics::Drug Therapy::Drug Prescriptions [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Inappropriate Prescribing, Infectious and parasitic diseases, RC109-216, Medicaments antifúngics - Ús terapèutic, :personas::Grupos de Edad::niño [DENOMINACIONES DE GRUPOS], Drug Prescriptions, Tertiary Care Centers, Antimicrobial Stewardship, :terapéutica::farmacoterapia::prescripciones de medicamentos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Surveys and Questionnaires, Prevalence, Humans, :Other subheadings::/therapeutic use [Other subheadings], Prospective Studies, Child, Antifungal therapy, :acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos [COMPUESTOS QUÍMICOS Y DROGAS], :Otros calificadores::/uso terapéutico [Otros calificadores], Paediatrics, :Persons::Age Groups::Child [NAMED GROUPS], Hospitals, Pediatric, Medicaments - Prescripció, Child, Preschool, :Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents [CHEMICALS AND DRUGS], Female, Antimicrobial management, Infants, Research Article, lcsh: lcsh:Infectious and parasitic diseases, lcsh: lcsh:RC109-216
Male, Antifungal Agents, Adolescent, :Therapeutics::Drug Therapy::Drug Prescriptions [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Inappropriate Prescribing, Infectious and parasitic diseases, RC109-216, Medicaments antifúngics - Ús terapèutic, :personas::Grupos de Edad::niño [DENOMINACIONES DE GRUPOS], Drug Prescriptions, Tertiary Care Centers, Antimicrobial Stewardship, :terapéutica::farmacoterapia::prescripciones de medicamentos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Surveys and Questionnaires, Prevalence, Humans, :Other subheadings::/therapeutic use [Other subheadings], Prospective Studies, Child, Antifungal therapy, :acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos [COMPUESTOS QUÍMICOS Y DROGAS], :Otros calificadores::/uso terapéutico [Otros calificadores], Paediatrics, :Persons::Age Groups::Child [NAMED GROUPS], Hospitals, Pediatric, Medicaments - Prescripció, Child, Preschool, :Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents [CHEMICALS AND DRUGS], Female, Antimicrobial management, Infants, Research Article, lcsh: lcsh:Infectious and parasitic diseases, lcsh: lcsh:RC109-216
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