Clinical pharmacist-led antifungal drug utilization reviews in cancer care hospital: a prospective audit and feedback.

Abstract

Background and objective: The global rise in systemic fungal infections and increased antifungal use underscores the need for pharmacist-led antifungal stewardship in oncology but data on such interventions are scarce. This study aimed to evaluate the clinical pharmacist-led antifungal drug utilization reviews for optimizing antifungal therapy in a specialized cancer care hospital.

Patients and method: This pharmacist-led prospective audit and feedback study evaluated 350 admitted patients with cancer who were prescribed systemic antifungals. Electronic medical records of the included patients were reviewed to evaluate pharmacist interventions. Data were entered and analysed through SPSS version 21.

Result: Most of the patients were prescribed antifungals for suspected fungal infections (41.7%). Febrile neutropenia was present in 55.4% of patients. The most frequently isolated fungus was C. albicans (15.4%) followed by C. tropicalis (8.6%) and A. flavus (7.7%). The most frequently prescribed antifungal drug was voriconazole (38.8%) and amphotericin B (31.7%). Major pharmacist-led interventions were a change of IV antifungal therapy to an oral drug (18%), choice of drug therapy (17.4%) and dose reduction (16.9%). All the interventions made by the pharmacist were accepted by the AFS team (100%).

Conclusion: Pharmacists play a crucial role in optimizing antifungal therapy by conducting drug utilization reviews and implementing targeted interventions. These interventions are beneficial for overall management of patients with cancer and improving the quality of antifungal prescribing.