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: 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: