[Assessment of adherence to Afssaps guidelines for the prescription of antifungals in pediatric hemato-oncology]

Evaluation of anti-infectives prescriptions in a pediatric hemato-oncological center: A retrospective study

INTRODUCTION

A few years after the discovery and development of anti-infectives, this therapeutic feat gave way to bacterial resistance because of the overconsumption of antibiotics, most often with unjustified prescriptions. The objective was to evaluate the compliance of the prescription of antibiotherapy in the pediatric onco-hematology unit of Rabat Children's Hospital and to determine the drug interactions.

MATERIAL AND METHODS

This is a retrospective study of anti-infectives prescriptions in pediatric onco-hematology. All prescriptions containing an antibiotic or antimycotic were isolated at the end of each month for analysis according to the ANSM standard. The variables of compliance analyzed in the prescriptions were: form, indication, posology, duration of the treatment, drug interactions and number of antibiotics which were prescribed.

RESULTS

The prescriptions containing at least one anti-infective were 195. All the prescriptions were in conformity with their indications; 111 (57%) of the cases were conform with respect to all criteria; 20 (12%) prescriptions were not conform in their form, 12 (6.6%) contained at least one over-dosed drug and 52 (26.7%) contained at least one under-dosed drug. A drug interaction was found in 15 (7.7%) of cases, of which 12 (6.2%) are precautions for use. A drug interaction is present in 1(6,7%) cases when a single antibiotic is prescribed against 3 (20%) cases when 4 antibiotics are prescribed. (p = 0.007).

CONCLUSION

The number of non-compliances in our study was high. It would therefore be advisable to recommend the establishment of an information system to minimize the non-compliances and to ensure a training program for young doctors on international recommendations.

[Adequacy of antifungal agents in a teaching hospital: too many inappropriate prescriptions despite training]

OBJECTIVES

The aim of this study was to assess adequacy and conformity of systemic antifungal drugs prescriptions in comparison with local, French, European and international recent guidelines in the Grenoble Teaching Hospital.

METHODS

Each prescription of itraconazole, liposomal amphotericin B, voriconazole, caspofungin, micafungin, posaconazole and anidulafungin made between February and October 2010 were reviewed by an infectious diseases specialist. Fluconazole prescriptions' were reviewed only for 15 days.

RESULTS

Two hundred and eight patients received 295 systemic antifungal prescriptions. Most of them had at least one risk factor and immunodeficiency was one of the most common. Antifungal treatment starting, molecules choice, administrations conformity (dosage, administration way) were appropriate in 126 cases on 208 (60.5 %) at the treatment beginning evaluation and in 171 cases on 295 (58 %) at the treatment ending evaluation. Antifungal combinations (9.4 %) were less frequent than in the study carried out in Grenoble teaching hospital in 2007 (16.3 %). Most common non-conformities encountered were use of caspofungin instead of fluconazole, antifungal combinations prescription, administration modalities misguiding. The economy that could have been generated by appropriate prescriptions represented 18 % of the antifungal budget of 2010 in the Grenoble Teaching Hospital.

CONCLUSION

An improvement was highlighted in the antifungal prescriptions in comparison to the previous study led in 2007 in the Universitary Grenoble Hospital. However, the antifungal use was not optimal and further training is planned.

A 6-year antifungal stewardship programme in a teaching hospital

PURPOSE

To describe the antifungal stewardship programme in our hospital and to assess its impact on total antifungal prescriptions and their cost, and on the process of care measures regarding the diagnostic and therapeutic management of invasive aspergillosis and candidaemia.

METHODS

We conducted a prospective observational study describing the multifaceted antifungal stewardship programme in place at our French teaching tertiary-care hospital since 2005. Several actions were implemented successively, including the systematic evaluation of all costly antifungal prescriptions (echinocandins, lipid formulations of amphotericin B, posaconazole and voriconazole).

RESULTS

A total of 636 antifungal prescriptions were discussed by the antifungal management team from 2005 to 2010 inclusive, mainly from the haematology department (72 %). In 344/636 cases (54 %), a piece of advice was fed back to the physician in charge of the patient, with an 88 % compliance rate. Optimal standard of care was achieved for galactomannan antigen testing, performance of chest computed tomography (CT) scan and voriconazole therapeutic drug monitoring for invasive aspergillosis, with no combination therapies used since 2008. Regarding candidaemia, optimal standard of care was achieved for the timing of antifungal therapy, recommended first-line therapy, duration of therapy and the removal of central venous catheters. Total antifungal prescriptions (in defined daily doses, DDD) and their cost were contained between 2003 and 2010.

CONCLUSIONS

The implementation of an antifungal stewardship programme was feasible, sustainable and well accepted. We observed an improved quality of care for some process of care measures, and antifungal use and cost were contained in our hospital.