Antifungal Drug Utilization in Selected Clinical Care Settings of a Tertiary Care Teaching Hospital

Documentation and analysis of use of antifungal therapy and its related adverse events (AE)/adverse drug reactions (ADRs) mainly aims at promotion of rational and safe use of antifungal agents for invasive fungal infections. Considering the complexity of diagnosis, high costs of therapy and high morbidity and mortality associated with systemic fungal infections, antifungal therapy should follow clearly defined guidelines.

Systemic antifungal treatments are very expensive, and are generally prescribed for a long duration. Routine and/or irrational use of drug regimens may expose a substantial portion of these patients to problems such as treatment failure, drug interactions and high risk of adverse events. In terms of successful therapy, current antifungal efficacy is limited by late diagnosis, limited diagnostic facilities, inadequate efficacy for many infections, adverse events and increasing rates of acquired resistance.

A careful antifungal stewardship programme in a tertiary care teaching hospital is essential to monitor these therapies in terms of extent and appropriateness of prescription, and to rationalize the use of these highly expensive drugs. So, the current prospective observational study will highlight the extent of use, adverse events, resistance pattern & eventually the overall prescription pattern of antifungal agents (AFAs) in selected clinical care setup such as MICU, PICU & Haematology ward.

This study will attempt to include about 100 patients admitted in Medical Intensive Care Unit (MICU)/Pediatric Intensive Care Unit (PICU)/Haematology ward & receiving Antifungal Therapy as a part of their treatment, over a period of 15 months. After approval from IEC and obtaining written ICD from the patients and/or LAR, data will be collected, and noted down in CRF. Evaluation of use will be on the basis of extent i.e. incidence of use as well as appropriateness. AE/ADR(s), if any, occurring in these patients will be recorded as per Central Drug Control Standard Organization (CDSCO) norms and later analyzed using WHO-UMC scale, Naranjo algorithm, modified Hartwig-Siegel scale, Schumock and Thornton scale.