Prescription audit of anti-fungal treatment of dermatophytoses in the Dermatology out patient department of a tertiary care hospital

Patients who were diagnosed with dermatophytoses infection in the Dermatology OPD, were recruited after obtaining their written informed consent or assent. These patients were followed up every 2 to 4 weeks for up to a total of 3 visits in case of treatment naive (New) patients and a total of 2 visits in case of patients already on anti-fungal therapy (Old cases). History of the patient was taken on the day of recruitment. The prescriptions were noted down at each visit. Clinical status was noted at each visit. Each patient was given a score of 0 to 3 for their symptoms of erythema, pruritus and desquamation based on their severity (Nil=0, Mild=1, Moderate=2, Severe=3). The patients were then categorised as clinically cured, clinical improvement and clinical failure groups. Blood samples for serum ALT levels were taken twice 2-4 weeks apart. In case of treatment naive patients, it was done on the 2nd and 3rd visits. In case of patients already on ongoing treatment, it was done on the 1st and 2nd visits. Availability of medications in the hospital pharmacy was checked at regular intervals. Patients who presented to the OPD for both the blood sample collection were considered to have completed the study.

Results:

Out of the 370 patients who were enrolled, 93 eventually completed the study. New and old cases constituted 46% and 54% of all patients respectively. The median age of patients was 33.5 years. The majority of patients (27.83%) belonged to the age group of 31-40 years. Males and females constituted 46% and 54% of the sample size respectively. The largest group of patients consisted of homemakers (34.86%) and students (18.64%). Tinea corporis constituted the highest number of cases (50.27%) followed by a combination of tinea corporis and tinea cruris (28.37%).

A total of 506 prescriptions were analysed. These included various formulations of anti-fungal drugs and anti-pruritic drugs. Azoles were the most commonly prescribed anti-fungal drug class. Clinical status of patients was independent of the oral anti-fungal drug prescribed. There was non-uniformity in the pharmacological management of patients who failed treatment. A statistically significant increase in serum ALT levels was seen (p<0.05) however, it was not clinically significant. About 55.52% drugs were unavailable in the hospital pharmacy during the entire duration of the study. This led to out-of -pocket expenses for patients. The average expenses per prescription for a duration of 3 weeks was INR 1123.55. Itraconazole regimen was found to be the most expensive for a duration of 3 weeks, followed by terbinafine and fluconazole.