The Utilization Pattern of Caspofungin in an Educational Hospital

Abstract

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.