PMID- 21720921
OWN - NLM
STAT- MEDLINE
DCOM- 20120625
LR  - 20211020
IS  - 1435-4373 (Electronic)
IS  - 0934-9723 (Linking)
VI  - 31
IP  - 3
DP  - 2012 Mar
TI  - Use of antifungal agents in pediatric and adult high-risk areas.
PG  - 337-47
LID - 10.1007/s10096-011-1315-x [doi]
AB  - 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.
FAU - Ramirez, E
AU  - Ramirez E
AD  - Clinical Pharmacology Service, Hospital Universitario La Paz, IdiPAZ, School of 
      Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo s/n, 28029, Madrid, 
      Spain. elena.ramirez@uam.es
FAU - Garcia-Rodriguez, J
AU  - Garcia-Rodriguez J
FAU - Borobia, A M
AU  - Borobia AM
FAU - Ortega, J M
AU  - Ortega JM
FAU - Lei, S
AU  - Lei S
FAU - Barrios-Fernandez, A
AU  - Barrios-Fernandez A
FAU - Sanchez, M
AU  - Sanchez M
FAU - Carcas, A J
AU  - Carcas AJ
FAU - Herrero, A
AU  - Herrero A
FAU - de la Puente, J M
AU  - de la Puente JM
FAU - Frias, J
AU  - Frias J
LA  - eng
PT  - Journal Article
DEP - 20110701
PL  - Germany
TA  - Eur J Clin Microbiol Infect Dis
JT  - European journal of clinical microbiology & infectious diseases : official 
      publication of the European Society of Clinical Microbiology
JID - 8804297
RN  - 0 (Antifungal Agents)
RN  - 0 (Echinocandins)
RN  - 0 (Lipopeptides)
RN  - 0 (liposomal amphotericin B)
RN  - 7XU7A7DROE (Amphotericin B)
RN  - 8VZV102JFY (Fluconazole)
RN  - F0XDI6ZL63 (Caspofungin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Amphotericin B/therapeutic use
MH  - Antifungal Agents/administration & dosage/*therapeutic use
MH  - Aspergillosis/*drug therapy
MH  - Aspergillus/drug effects
MH  - Candida/drug effects
MH  - Candidiasis/*drug therapy
MH  - Caspofungin
MH  - Child
MH  - Child, Preschool
MH  - Drug Utilization/*statistics & numerical data
MH  - Echinocandins/therapeutic use
MH  - Female
MH  - Fluconazole/therapeutic use
MH  - Humans
MH  - Immunocompromised Host
MH  - Inappropriate Prescribing/statistics & numerical data
MH  - Infant
MH  - Intensive Care Units
MH  - Lipopeptides
MH  - Male
MH  - Middle Aged
MH  - Mycoses/*drug therapy/prevention & control
MH  - Prospective Studies
MH  - Transplantation
MH  - Young Adult
EDAT- 2011/07/02 06:00
MHDA- 2012/06/26 06:00
CRDT- 2011/07/02 06:00
PHST- 2010/12/19 00:00 [received]
PHST- 2011/06/01 00:00 [accepted]
PHST- 2011/07/02 06:00 [entrez]
PHST- 2011/07/02 06:00 [pubmed]
PHST- 2012/06/26 06:00 [medline]
AID - 10.1007/s10096-011-1315-x [doi]
PST - ppublish
SO  - Eur J Clin Microbiol Infect Dis. 2012 Mar;31(3):337-47. doi: 
      10.1007/s10096-011-1315-x. Epub 2011 Jul 1.