Document 0355
 DOCN  M9460355
 TI    Use of antifungal therapy in hospitalized patients. I. Results prior to
       the marketing of fluconazole.
 DT    9408
 AU    Grasela TH; Goodwin SD; Pasko MT; Walawander CA; Raebel MA; Center for
       Pharmacoepidemiology Research, State University of New; York (SUNY) at
       Buffalo.
 SO    Ann Pharmacother. 1994 Feb;28(2):252-60. Unique Identifier : AIDSLINE
       MED/94227316
 AB    OBJECTIVE: To evaluate the use of antifungal agents in hospitalized
       patients prior to marketing of fluconazole and to assess characteristics
       associated with their use. DESIGN: A cohort of hospitalized patients
       receiving topical or systemic antifungal therapy was monitored
       concurrently. SETTING: Sixty-nine hospitals ranging in size from 100 to
       more than 500 beds, 70.1 percent affiliated with medical schools.
       PATIENTS: Participating clinical pharmacists each identified 15
       consecutive patients receiving systemic antifungal therapy and 5
       consecutive patients receiving topical antifungal therapy at their
       institutions. Data collection began October 1989 and ended March 1990.
       INTERVENTION: All data collected were observational in nature, and no
       patient intervention was required. MEASURES: Characteristics of patients
       receiving antifungal therapy were compared using t-tests and chi-square
       tests. Utilization and patterns of use of antifungal therapy were
       reported. RESULTS: The most common risk factors necessitating antifungal
       therapy, in descending order, were: administration of broad-spectrum
       antibiotics and/or presence of invasive catheters, carcinoma, AIDS,
       leukemia or lymphoma, diabetes mellitus, solid organ or bone marrow
       transplantation, and chronic obstructive pulmonary disease. Five hundred
       seventeen patients received systemic therapy and 464 (89.7 percent)
       received a single systemic agent. Of these, 242 (52.2 percent) received
       amphotericin B, 215 (46.3 percent) received ketoconazole, 6 (1.3
       percent) received flucytosine, and 1 (0.2 percent) received intravenous
       miconazole. Fifty-three patients received two systemic agents either
       concurrently or consecutively. Ketoconazole was most often used for
       presumed or documented oral, urogenital, or esophageal infections and
       amphotericin B was the preferred agent for disseminated infections and
       fungemia (p < 0.001). Almost half of the patients receiving amphotericin
       B or ketoconazole (48.3 percent) received these drugs as empiric
       therapy. Documented infections were more likely to be treated with
       amphotericin B (54.8 percent) than with ketoconazole (27.4 percent) (p <
       0.001). The predominant fungal isolates were Candida albicans, Candida
       spp., and unspecified yeasts. Amphotericin B toxicity led to
       discontinuation of drug therapy in only 5.1 percent of cases. Two
       hundred sixty-nine patients (34.2 percent) received topical antifungal
       therapy only. Nystatin oral suspension was prescribed to 65.3 percent of
       the patients, clotrimazole troches to 23.0 percent, amphotericin B
       irrigation to 10.9 percent, and nystatin tablets to 0.8 percent.
       CONCLUSIONS: The utilization patterns of antifungal agents in this
       survey follow established therapeutic guidelines. Prior to the
       introduction of fluconazole, amphotericin B was the agent of choice for
       documented systemic fungal infections. Ketoconazole was more often used
       for prophylaxis of fungal infections and treatment of oral and
       esophageal infections.
 DE    Amphotericin B/THERAPEUTIC USE  Antifungal Agents/ADMINISTRATION &
       DOSAGE/*THERAPEUTIC USE  AIDS-Related Opportunistic Infections/DRUG
       THERAPY  Comparative Study  Drug Utilization/*STATISTICS & NUMER DATA
       Hospitals/*STATISTICS & NUMER DATA  Human  Ketoconazole/THERAPEUTIC USE
       Mycoses/*DRUG THERAPY  Nystatin/THERAPEUTIC USE  Prospective Studies
       Risk Factors  United States  JOURNAL ARTICLE  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).