Use of fluconazole in daily practice: still room for improvement

• Published in: Journal of antimicrobial chemotherapy Vol. 48; no. 2; pp. 303 - 310
• Main Authors: Natsch, S., Steeghs, M. H. M., Hekster, Y. A., Meis, J. F. G. M., van der Meer, J. W. M., Kullberg, B. J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-08-2001; Oxford Publishing Limited (England)
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - therapeutic use; Biological and medical sciences; Communicable Diseases - drug therapy; Drug Prescriptions - statistics & numerical data; Drug Utilization Review - statistics & numerical data; Fluconazole - administration & dosage; Fluconazole - therapeutic use; Humans; Medical sciences; Mycoses - drug therapy; Pharmacology. Drug treatments; Netherlands; Yeast; Fluconazole; Fungi; Prevention; Antifungal agent; Chemotherapy; Treatment; Medical prescription; Candida; Triazole derivatives; Fungi Imperfecti; Hospital; Thallophyta
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/48.2.303

One hundred courses of fluconazole treatment in a university hospital and 81 courses in a non-university teaching hospital have been analysed in a prospective audit to evaluate prescribing practices. The quality of treatments was assessed by an infectious disease specialist and a pharmacist according to standard guidelines. In the non-university hospital, prescribed dosages were lower than in the university hospital, and often below the recommended dose. Mean duration of treatment for oesophageal candidosis and disseminated infections was considerably shorter in the non-university hospital compared with the university hospital, and often judged too short. Microbiological samples were examined in 75% of the cases in both hospitals. The expert reviewers agreed with the indication to use fluconazole in 58–100% of cases in the university hospital and 42–80% in the non-university hospital, depending on the type of infection. There did not appear to be a major problem with inappropriate use of fluconazole. However, important issues for improvement could be identified, such as increasing the dosage and duration of treatment in cases of serious infections, and withholding treatment from patients with colonization rather than infection.