Systemic Antifungal use in a Pediatric Cancer Center - Audit Comparing Pharmacy Dispensing Data with Patient - Derived Consumption

Abstract

Background: The critical analysis of systemic antifungal use in pediatric cancer patients may elucidate targets for antifungal stewardship in the prophylaxis and treatment of Invasive Fungal Infection (IFI). Hitherto, any correlation between pharmacy dispensing data (antifungals) and patient-derived consumption in g/100 inpatient days is unknown. Methods: Retrospective audit (April 2016 - June 2018) of systemic antifungal use in a pediatric cancer center comparing pharmacy dispensing and patient derived consumption data. Results: Out of 203 consecutive patients, 18.7% received at least one cycle of systemic antifungal treatment (in total 86 cycles). The main antifungals used were fluconazole, liposomal amphotericin B and caspofungin. Concerning the indication, 44 cycles referred to IFI prophylaxis, and 42 to therapy (28 empirical, 9 pre-emptive, 5 probable IFI). Pharmacy dispensing data for systemic antifungals (in g/100 inpatient days) showed no correlation to patient-derived consumption data and were 2.13 times higher. Discussion & conclusion: Pharmacy dispensing data do not realistically depict the actual use of antifungals in pediatric cancer patients. Patient - and case - related analyses and the implementation of electronic patient records are essential for a more precise analysis, paving the way for an antifungal stewardship program.