scholarly journals Implementation of Pharmacist-driven Antifungal Stewardship Program in A Tertiary Care Hospital

2021 ◽  
Author(s):  
Emre Kara ◽  
Gokhan Metan ◽  
Aygin Bayraktar-Ekincioglu ◽  
Dolunay Gulmez ◽  
Sevtap Arikan-Akdagli ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Clinical Pharmacist ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Antifungal Stewardship ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Antifungal Use

Objectives: Antifungal stewardship (AFS) is recommended to reduce the inappropriate use of antifungal drugs. In this study, the role of AFS in providing appropriate antifungal therapy was evaluated. Methods: This study included three periods as observation, feedback/education, and daily AFS activities. In observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In second period, monthly meetings were organized to provide feedback and education to physicians regarding antifungal therapy and the rate of adherence to the clinical guidelines. In final period, a clinical pharmacist participated in daily ward rounds to evaluate appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Results: Four hundred and eighteen episodes of antifungal therapy were evaluated. Baseline demographics of patients were similar in all three periods for age, gender, and the number of comorbidities. The indications for antifungal use were for prophylaxis in 22.7%, Candida infections in 58.6%, and invasive mould infections in 18.7%. During the third period, 157 (78.9%) recommendations were made and 151 (96.2%) were accepted. The overall appropriateness of antifungal use increased significantly for prophylaxis (30.8%, 17.9%, 46.3%, p=0.046) and treatment of fungal diseases (27.8%, 32.4%, 71.9%, p<0.001) between the first, second and third periods, respectively. A 30-day mortality was not significantly changed between the three periods (19%, 15.6% and 27.5%; p=0.050). Conclusions: Appropriateness in antifungal therapy can be augmented by the integration of an AFS program. A team-based evaluation of fungal infections and assessment of patients by a clinical pharmacist with a therapeutic perspective may help to increase the quality of antifungal therapy.

Impact of Education and an Antifungal Stewardship Program for Candidiasis at a Thai Tertiary Care Center

2010 ◽  
Vol 31 (7) ◽  
pp. 722-727 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Apiwat Yatrasert ◽  
Linda M. Mundy ◽  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Antifungal Stewardship ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
Antifungal Use ◽  
The Impact

Background.We evaluated the impact of education and an antifungal stewardship program for candidiasis on prescribing practices, antifungal consumption, Candida species infections, and estimated costs at a Thai tertiary care hospital.Methods.A hospital-wide, quasi-experimental study was conducted for 1.5 years before the intervention and 1.5 years after the implementation of an antifungal stewardship program. Inpatient antifungal prescriptions were prospectively observed, and patients' demographic, clinical, and administrative-cost data were collected. Interventions included education, introduction of an antifungal hepatic and/or renal dose adjustment tool, antifungal prescription forms, and prescription-control strategies.Results.After the intervention, there was a 59% reduction in antifungal prescriptions (from 194 to 80 prescriptions per 1,000 hospitalizations; P < .001). Inappropriate antifungal use decreased (from 71% to 24%; P < .001), a sustained reduction in antifungal use was observed (r = 0.83; P < .001), and fluconazole use decreased (from 242 to 117 defined daily doses per 1,000 patient-days; P < .001). Reductions in the incidence of infection with Candida glabrata (r = 0.69; P < .001) and Candida krusei (r = 0.71; P < .001) were observed, whereas the incidence of infection with Candida albicans (r = —0.81; P < .001) increased. Total cost savings were US$31,615 during the 18-month postintervention period.Conclusions.Implementation of an antifungal stewardship program was associated with appropriate antifungal drug use, improved resource utilization, and cost savings.

Impact of a non-compulsory antifungal stewardship program on overuse and misuse of antifungal agents in a tertiary care hospital

2021 ◽  
Vol 57 (1) ◽  
pp. 106255
Author(s):  
Antonios Markogiannakis ◽  
Konstantinos Korantanis ◽  
Maria N. Gamaletsou ◽  
Michael Samarkos ◽  
Mina Psichogiou ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Antifungal Stewardship ◽  
Stewardship Program

scholarly journals A pharmacoepidemiology study of local fungal infections in skin and venereal diseases outpatient department of a rural tertiary care hospital

2020 ◽  
Vol 9 (4) ◽  
pp. 616
Author(s):  
Preety Bansal ◽  
Seema Baishnab
Keyword(s):  
Fungal Infection ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Dermatology Department ◽  
Number Of Patients ◽  
Common Skin ◽  
Cutaneous Fungal Infection ◽  
Number Of Males

Background: Fungal infections of the skin were the 4th most common skin disease in 2010 affecting 984 million people. An estimated 20-25% of the world’s population has some form of fungal infection. Dermatophytes are fungi that cause superficial infections of the skin, commonly referred to as tinea infections.Methods: This was a prospective and an observational study conducted from February 2018 to January 2019 in Dermatology Department. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sex who attended dermatology OPD. Factors considered were sociodemographic parameters, the disease encountered and number of patients in each group and number of patients who received antifungal therapy (oral and topical) etc.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. There were a greater number of males (57.4%) than females (42.6%). The average number of antifungal drugs prescribed per prescription was 2.33. Majority of the patients were prescribed itraconazole (82.30%) followed by terbinafine (9.70%) and fluconazole (8.0%).Conclusions: The most common oral antifungal drug used was itraconazole. Ketoconazole and Terbinafine were the most commonly used topical agents respectively.

scholarly journals An Update on Secondary Bacterial and Fungal Infections and Their Antimicrobial Resistance Pattern (AMR) in COVID-19 Confirmed Patients at a Tertiary Care Hospital

2022 ◽  
Author(s):  
Sushma Yadav Boorgula ◽  
Sadhana Yelamanchili ◽  
Pragathi Kottapalli ◽  
Mohini D. Naga
Keyword(s):  
Antimicrobial Resistance ◽  
Fungal Infections ◽  
Treatment Options ◽  
Tertiary Care ◽  
Clinical Samples ◽  
Resistance Pattern ◽  
P Value ◽  
Care Hospital ◽  
Stewardship Program ◽  
Secondary Infections

Abstract Introduction Since coronavirus disease 2019 (COVID-19) has limited treatment options, concern has been raised over secondary infections and antimicrobial resistance (AMR) patterns. It has been observed that patients who were infected with COVID-19 were predisposed to develop secondary infections. The purpose of the study is to ascertain the prevalence of the bacterial and fungal coinfections in COVID-19 patients, and also to assess the AMR patterns in the obtained isolates. Methods We have studied 200 clinical samples obtained from 122 COVID-19 positive patients. Pathogens were identified using Vitek 2 system. The demographic and clinical patterns were also observed. Results A total of 122 patients developed secondary infections. Patients aged more than 40 years were majorly affected (p-value < 0.0001). Respiratory samples (n = 96) were predominant. Klebsiella pneumoniae (n = 68) was the most common pathogen isolated followed by Acinetobacter baumannii (n = 54) and an overall 6% rise in the Carbapenem resistance was observed in the isolates. Conclusion To contain the secondary infections in COVID-19 patients, it is imperative to adhere to antimicrobial stewardship program and timely revise the empirical antibiotic policy.

scholarly journals Drug prescribing pattern of antifungal drugs for local fungal infections in a tertiary care hospital: MAMC, Agroha

2021 ◽  
Vol 10 (6) ◽  
pp. 689
Author(s):  
Preety Bansal ◽  
Seema Baishnab ◽  
Ashima Singla
Keyword(s):  
Drug Utilization ◽  
Tertiary Care Hospital ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Economic Consequences ◽  
Care Hospital ◽  
Drug Prescribing ◽  
Prescribing Practices ◽  
Prescribing Pattern

Background: Drug utilization research or studies are the powerful exploratory tools to ascertain the role of drugs in the society which refers to the marketing, distribution, prescription and use of drugs with special emphasis on the medical, social and economic consequences. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and promote rational prescribing.Methods: This was a prospective and an observational study. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sexes who attended dermatology OPD. Factors considered were sociodemographic parameters and WHO prescribing indicators.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. The average number of drugs per encounter was 3.68. The percentage of drugs prescribed by generic name was 50.33% and the percentage of drugs prescribed from NLEM was 20.93%.Conclusions: This study indicates that prescribing practices of drugs in tertiary care hospital can be improved by promoting generic name drug prescribing, prescribing drugs from NLEM and by reducing polypharmacy.

scholarly journals Clinico-mycological Study of Dermatophytosis and Their Antifungal Susceptibility, A Hospital Based Study

2021 ◽  
Vol 19 (1) ◽  
pp. 30-36
Author(s):  
Manish Bhakta Pradhan ◽  
Vikash Paudel
Keyword(s):  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Common Species ◽  
Antifungal Drugs ◽  
Outpatient Department ◽  
Care Hospital ◽  
Disk Diffusion Test ◽  
Female Ratio

Background: Dermatophytosis refers to superficial fungal infections of keratinized tissues caused by keratinophilic dermatophytes. It is the most common of the superficial fungal infections. Nowadays, these fungal infections are at a rise and run a prolonged course despite of treatment due to resistance to conventional antifungal agents. There is a felt need to conduct an epidemiological studies to know the change in the pattern and causes of widespread resistance. Objectives: This study was aimed at identifying clinico-mycological patterns of dermatophytic infections in patients attending the dermatology outpatient department of a tertiary care hospital in Birgunj and the adjoining areas. Methods: The study included cases of clinically diagnosed dermatophytosis from the outpatient department of Dermatology of National Medical College, Birgunj. Clinical and epidemiological data were collected as per proforma and skin scraping, hair plucking, and nail clipping were done and materials were examined microscopically by KOH mount then cultured on Sabouraud dextrose agar and antifungal susceptibility were done by disk diffusion test. Results: here were 349 patients recruited in the study, with a male: female ratio of 1.6:1. The most commonly affected age group was 20–29 years (27.3%). Tinea corporis was the most common type observed (38.1%). Potassium hydroxide positivity was seen in 228 samples (65.3%) and culture positivity was found in 202 samples (57.9%). The most common species identified was Trichophyton rubrum (55%). The most sensitive drug was itraconazole, and more number of resistances was noted with fluconazole. Conclusion: Dermatophytic infection is ecumenical in distribution with increased frequency in tropical and subtropical countries with variable epidemiology. Inadequate and irregular use of antifungal drugs has led to the emergence of resistant strains, which cause poor treatment outcomes. Thus, it is essential to test for antifungal sensitivity to check for resistance to antifungals.

scholarly journals Prospective Observational Study on Prescribing Pattern of Antifungal Drugs in the 400 Out-Patient Department of Dermatology in a Tertiary Care Hospital

2021 ◽  
Vol 14 (1) ◽  
pp. 311-316
Author(s):  
Rashmeen Naaz ◽  
Sharad Chand ◽  
Nandakumar UP ◽  
Vinay BC ◽  
Bharath Raj KC ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Fungal Disease ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Prescribing Pattern ◽  
Cost Variability ◽  
Serious Disease

Introduction: Fungal infections have been a serious disease over a few decades. Superficial fungal infections not only cause life-threatening illnesses but slowly reduce the Quality of life of patients. Objective: To study the prescribing pattern of antifungal drugs, distribution of fungal disease, and cost variability between different antifungal drugs prescribed. Materials and methods: Prospective observational study was carried out at Justice K.S. Hegde Charitable Hospital from August 2018 to April 2019. Outpatient departments patient satisfying the inclusion criteria were included in the study. Factors like age, gender, diagnosis, and type of prescribed antifungal drugs along with Price variability among different brands of the drug were considered. Antifungal drug prescriptions of patients were analyzed. Results: More than 50% of the patients were from age 21-40 yrs. Males (51.8%) were more than females (48%). The majority of the drugs prescribed were topically (64%). Tine a corpor is was the most prevalent fungal disease. The Azoles group of Antifungal was most prescribed. And the percentage variability between different brands was high. Conclusion: The study concluded the extensive use of antifungal agents. The highly prescribed drug was found to be luliconazole. The study also concluded that the use of generic prescriptions might reduce the cost of illness and enhance the rational use of the drug.

A study on the antifungal susceptibility pattern of dermatophytes isolated in a tertiary care hospital

2017 ◽  
Vol 6 (05) ◽  
pp. 5379
Author(s):  
Vanathi Sabtharishi* ◽  
Radhika Katragadda ◽  
Thyagarajan Ravinder
Keyword(s):  
Tertiary Care Hospital ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Dilution Method ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Superficial Mycosis ◽  
Broth Dilution ◽  
Common Infections

Recent years, due to increased usage of antifungal treatment worldwide, there is an increased chance of rising resistance among antifungal drugs too. Dermatophytic infections causes’ superficial mycosis and it affects skin, hair and nail. These infections are more common and antifungal drugs are used everywhere to treat those common infections. To conduct a study by determining the antifungal susceptibility pattern in dermatophytic isolates from patients attending dermatology OPD in a tertiary care hospital. A total of 217 samples like hair, nail and skin scrapings were obtained and isolation of dermatophytes was done. Antifungal susceptibility testing for dermatophytes was performed by micro broth dilution method. Antifungal drugs tested were Griseofulvin, Fluconazole, Itraconazole and Ketoconazole. Minimum inhibitory concentration for each drug for fungal isolates was tested and results studied. Fluconazole showed a higher MIC values in the range of 1-8µg/ml. Itraconazole showed the lowest MIC values by micro broth dilution method. Since there is limitation of standard guidelines and protocol, meticulous research must be conducted on effect of antifungals and derive at universally implementable guidelines.

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

2021 ◽  
pp. 107815522110293
Author(s):  
Amanda V Pirolli ◽  
Tatiana Brusamarello ◽  
Stella S Everton ◽  
Vânia M S Andrzejevski
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Structured Interview ◽  
Care Hospital ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancers

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

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