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M9460736.TXT
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1994-06-25
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Document 0736
DOCN M9460736
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).