The Utilization Pattern of Caspofungin in an Educational Hospital
Purpose: Caspofungin is prescribed for systemic treatment of fungal infections and correct prescription pattern is an issue of importance. Hence in this study the Caspofungin utilization and the frequency rate of medication errors were investigated at a training hospital in a developing country.
Methods: In this cross-sectional descriptive comparative study 43 consecutive patients receiving Caspofungin in Firoozgar Hospital, Tehran, Iran from March to September 2017 were enrolled. The prescription frequency of the drug was compared with the national data and the suggested rates by World Health Organization.
Results: The prescription rate was higher in Intensive Care Unit with 72.1% rate. Infectious disease specialists were responsible for Caspofungin prescription only in 11 cases (25.5%). The cause of Caspofungin prescription was unknown in 18.6% of cases; but experimental treatment for febrile neutropenia and ICU patients with Candida Score > 2.5 were the most known causes. The drug administration in 11 cases (25.6%) occurred in less than one hour. The indication of treatment was incorrect in 12 out of 43 cases (28%). On the first day of the treatment a dose of both 70 mg and 50 mg was prescribed, which was higher than the appropriate dose and also it was lower than the optimal dose in five cases (83.7%). The mean treatment duration was 10.88 ± 5.35 days ranging from 2 to 24 days. The duration of treatment was correct in 20 cases (46.5%) and incorrect in 23 patients (53.5%).
Conclusion: According to the obtained results, it may be concluded that in comparison with the international guidelines there are multiple discordance in our setting including inappropriate duration, continuation, and indications. Hence these should be announced to the physicians for further cautions in this area, and it is better to consult with infectious diseases specialists for the administration of anti-fungal drugs.
2. Ahmed SM, Islam QS. Availability and rational use of drugs in primary healthcare facilities following the national drug policy of 1982: is Bangladesh on right track? Journal of Health, Population and Nutrition. 2012:99-108.
3. Organization WH. How to investigate drug use in health facilities: selected drug use indicators. 1993.
4. Organization WH. Promoting rational use of medicines: core components. 2002
5. Simpson G, Das G. Indian hospital drug use study shows need to improve prescribing. Essential Drugs Monitor. 2003;32:23.
6. Javadi M KH, Solaimani F, Gholami KH. Rational prescription of drug. Tehran: Andishe Mandegar; 2008.
7. Patanwala AE, Warholak TL, Sanders AB, Erstad BL. A prospective observational study of medication errors in a tertiary care emergency department. Annals of emergency medicine. 2010 Jun;55(6):522-6.
8. Fahimi F, Soleymani F, Tavakoli-Ardakani M. Vancomycin Utilization Evaluation in a teaching hospital: A case- series study in Iran. Journal of Pharmaceutical Care 2013; 1(2): 51-4.
9. Distribution of General Practitioners in the Health System of Iran Using Equity Indices (Gini, Atkinson. 2. 2015;4(3):247-0.
10. Sepehri GR, Haj Akbari N, Mousavi A. Prescribing patterns of general practitioners in Kerman province ofIran, 2003. Journal of Babol University Of Medical Sciences. 2005;7(4):76-82.
11. Phillips MS, Gayman JE, Todd MW. ASHP guidelines on medication-use evaluation. American Society of Health system Pharmacists. Am J Health Syst Pharm 1996; 53(16): 1953-5.
12. Duke Antimicrobial Stewardship Outreach Network (DASON). Antimicrobial medication use evaluations (MUE) for community hospitals. Antimicrobial Stewardship News 2015; 3(7): 1-4.
13. Li J, Udy AA, Kirkpatrick CM, Lipman J, RobertsJA. Improving vancomycin prescription in critical illness through a drug use evaluation process: A weight-based dosing intervention study. Int JAntimicrob Agents 2012; 39(1): 69-72.
14. Lewis RE. Pharmacology of echinocandins. UpTodate [Online]. [cited 2017 Sep 29]; Available from: URL:https://www.uptodate.com/contents/pharmacology-ofechinocandins?source=search_result&search=echinocandins&selectedTitle=1~56%5D
15. Cai MY, Lin CX, Huang WW. Efficacy analysis of Caspofungin for non-effect/intolerant to fluconazole in patients with invasive fungal infection in intensive care unit. China Pharmacy 2010; 24: 028.
16. Kubiak DW, Bryar JM, McDonnell AM, Delgado-Flores JO, Mui E, Baden LR, et al. Evaluation of Caspofungin or Micafungin as empiric antifungal therapy in adult patients with persistent febrile neutropenia: a retrospective, observational, sequential cohort analysis. Clin Ther 2010; 32(4): 637-48.
17. Hayatshahi A, Javadi M, Torkamandi H, Hadjibabaie M, Alahyari S, Gholami K, et al. Drug utilization review of vancomycin in febrile neutropenic patients hospitalized at a bone marrow transplantation center. Int J Hematol Oncol Stem Cell Res. 2010; 4(3): 10-3.
18. Michalopoulos AS, Geroulanos S, Mentzelopoulos SD. Determinants of candidemia and candidemia-related death in cardiothoracic ICU patients. Chest 2003; 124(6): 2244-55.
19. eMC. CANCIDAS 50 mg (formerly Caspofungin MSD) [Online]. [cited 2016 Jul 25]; Available from: URL: https://www.medicines.org.uk/emc/medicine/12843/S PC/CANCIDAS+(formerly+Caspofungin+MSD)/#P RODUCTINFO
20. Al Balushi KA, Alzaabi MA, Alghafri F. Prescribing Pattern of Antifungal Medications at a Tertiary Care Hospital in Oman. J Clin Diagn Res. 2016 Dec;10(12):FC27-FC30.
21. Chandwani S, Wentworth C, Burke TA, Patterson TF. Utilization and dosage pattern of echinocandins for treatment of fungal infections in US hospital practice. Curr Med Res Opin. 2009 Feb;25(2):385-93.
22. Thompson GR 3rd, Wiederhold NP, Vallor AC, Villareal NC, Lewis JS 2nd, Patterson TF. Development of Caspofungin resistance following prolonged therapy for invasive candidiasis secondary to Candida glabrata infection. Antimicrob Agents Chemother. 2008 Oct;52(10):3783-5.