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European Journal of Clinical Microbiology & Infectious Diseases
Published in: European Journal of Clinical Microbiology & Infectious Diseases 3/2012

01-03-2012 | Article

Use of antifungal agents in pediatric and adult high-risk areas

Authors: E. Ramírez, J. García-Rodríguez, A. M. Borobia, J. M. Ortega, S. Lei, A. Barrios-Fernández, M. Sánchez, A. J. Carcas, A. Herrero, J. M. de la Puente, J. Frías

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 3/2012

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Abstract

The purpose of this investigation was to describe the characteristics of the use of systemic antifungal agents (AFAs) and to evaluate their appropriateness of use. A prospective drug-utilisation study was conducted in intensive-care areas: haematology-oncology services and transplant units. Data were collected in three periods over 9 months. The required sample size was determined to be 113 patients (margin of error ±7%, 95% confidence interval [CI]), assuming a variability of 50%. Two different investigator groups evaluated the appropriateness of use separately; Cohen’s Kappa index was used to calculate the degree of agreement between groups. A total of 114 patients we included, of which 62 (54.4%) were children. A total of 150 prescriptions were administered; fluconazole was the most frequently prescribed (38%), followed by liposomal amphotericin B (22.7%) and caspofungin (18.7%). The indications were: (1) pre-emptive treatment of Candida in non-neutropaenic critically ill patients (35.1%), (2) treatment of systemic fungal infection (24.6%), (3) prophylaxis for systemic fungal infection (SFI) in immunocompromised patients (16.7%), (4) prophylaxis of SFI in transplant recipients (12.3%), (5) prophylaxis of SFI in preterm infants (5.3%), (6) treatment of SFI in neonates (6.1%). The Kappa index showed a substantial agreement (Kappa = 0.73). The indications were considered to be inappropriate in 71 (47.3%) episodes. The indications or dosages were inappropriate in 79 cases (52.7%). The indications, dosages or duration of treatment were inappropriate in 83 cases (55.3%). We conclude that AFAs are prescribed for a significant number of inappropriate indications.
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Metadata
Title
Use of antifungal agents in pediatric and adult high-risk areas
Authors
E. Ramírez
J. García-Rodríguez
A. M. Borobia
J. M. Ortega
S. Lei
A. Barrios-Fernández
M. Sánchez
A. J. Carcas
A. Herrero
J. M. de la Puente
J. Frías
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
European Journal of Clinical Microbiology & Infectious Diseases / Issue 3/2012
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-011-1315-x

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