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Drug utilization study of systemic antifungal agents in a Brazilian tertiary care hospital

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Abstract

Background The inappropriate use of systemic antifungal agents can result in unnecessary exposure, adverse events, increased microbial resistance and increased costs. Aim This study analysed the use of systemic antifungal agents and adherence to treatment guidelines for fungal infections. Setting A Brazilian tertiary hospital. Methods This cross-sectional study investigated 183 patients who were treated with systemic antifungals. Antifungal drugs were classified according to the fourth level of the Anatomical Therapeutic Chemical classification system. The appropriateness of treatments was analysed with respect to the indication, dose and potential drug–drug interactions. Descriptive and univariate statistical analyses were performed. The main outcome measure was the frequency of adherence to treatment guidelines for fungal infections. Results The number of established treatments was 320, with 163 (50.9 %) pre-emptive, 63 (19.7 %) targeted, 56 (17.5 %) empirical and 38 (11.9 %) prophylactic treatments. The overall adherence to the treatment guidelines was 29.4 %. The proportion of appropriate treatment considering indication, dosage and drug–drug interactions was 84.1, 67.8 and 47.2 %, respectively. The most commonly prescribed systemic antifungal agents were fluconazole in 170 (53.1 %), voriconazole in 43 (13.4 %) and amphotericin B deoxycholate in 36 (11.3 %) cases. Conclusion The study showed a low proportion of appropriate antifungal drug use; the dosage and drug–drug interactions criteria were the determining factors for the high percentage of non-adherence to treatment guidelines in the hospital. The profile of antifungal agents used showed the predominance of fluconazole as well as the use of new antifungal drugs.

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Acknowledgments

The authors would like to acknowledge the Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais for supporting this publication through the Qualitative Improvement Program of Scientific Production and Fundação de Apoio a Pesquisa de Minas Gerais-FAPEMIG for providing a scientific initiation scholarship.

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Authors and Affiliations

  1. Hospital das Clínicas, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Minas Gerais, Brazil

    Maria Clara Padovani de Souza

  2. Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil

    Andrezza Gouvêa dos Santos & Adriano Max Moreira Reis

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  1. Maria Clara Padovani de Souza
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  2. Andrezza Gouvêa dos Santos
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  3. Adriano Max Moreira Reis
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Correspondence to Adriano Max Moreira Reis.

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de Souza, M.C.P., dos Santos, A.G. & Reis, A.M.M. Drug utilization study of systemic antifungal agents in a Brazilian tertiary care hospital. Int J Clin Pharm 38, 1398–1406 (2016). https://doi.org/10.1007/s11096-016-0382-6

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