The Utilization Pattern of Caspofungin in an Educational Hospital

Please cite this paper as: Ramezaninejad S, Amouzegar A, Aghabeigi S, Farasati Nasab M, Ranjbar M, Jamshidi M, Ghanbari B, Pakdaman N, Khorsani M. The Utilization Pattern of Caspofungin in an Educational Hospital. J Pharm Care 2019; 7(3): 54-58. 2019 Introduction Development of a scientific rational drug delivery system in hospitals is crucial (1-3). The evaluation of drug prescription in hospitals with appropriate rational patterns would result in decreased costs, less medication errors and increased efficiency (4-6). In fact in a hospital the number of drugs, rate of the prescribed antibiotics, and number of 55 Ramezaninejad et al. November 2019;7(3) jpc.tums.ac.ir injection drugs are indicators of correct drug prescription and criteria for assessing physicians’ functionality (3). Inappropriate drug use in hospitals is seen in both developed and developing countries (1), which can be monitored and prevented easily by physicians (7-10). Drug utilization evaluation (DUE) in hospitals, especially for the antibiotics and anti-fungal agents in arrangement with an accurate pattern of use, is the initial executive step that can be taught in training hospitals (11). Such studies may focus on the drug or the therapeutic course, drug use, and administration (12, 13). Antifungal use is a common practice in hospitals for many infectious diseases worldwide but with a higher frequency in developing countries such as Islamic Republic of Iran (14-16). Caspofungin is prescribed for the systemic treatment of fungal infections and its true and correct prescription pattern is an issue of importance (14). Caspofungin is an intravenous antifungal lipoprotein derivative, which is a new echinocandin antifungal agent with an action mechanism that targets a structural component of the fungal cell wall including 1,3-Beta glucan synthase with inhibitory action (14). It may be used to treat Aspergillusis, Candidiasis, and Cryptococcus neoformans. The possible side effects include fever, headache, liver enzyme increase, anaphylaxis, phlebitis, tachycardia, paresthesia, and gastrointestinal complaints (15, 16). The main gap detected by the authors of this novel study is that in the previous studies conducted in the Middle East, the efficacy and safety of Caspofungin were investigated but the drug’s prescription pattern was rarely evaluated. Hence in this study the main objective is finding a probable answer to the following research questions: 1) What should the correct utilization pattern of Caspofungin be like, and 2) how much is the frequency rate of medication errors at a training hospital in a developing country. The appropriateness of Caspofungin’s prescription is assessed based on Sanford and Infectious Disease Society of America (IDSA) Guidelines. Methods This cross-sectional study enrolled 43 consecutive patients receiving Caspofungin in Firoozgar Hospital, Tehran, Iran from March to September 2017. All prescriptions either with or without insurance coverage were gathered through examining the patients’ archived medical files, using existing medical documents in the hospital’s pharmacy. The exclusion criterion was incomplete documents. The study was approved by local ethical committee at Iran University of Medical Sciences. The prescription frequency of the drug was compared with the data standardized by Iranian Health Ministry in Drug and Food Department and the suggested rates by IDSA and Sanford Guideline. Also the indications for Caspofungin prescription were determined by a revision of existing medical data. Consequently, reasons as to why Caspofungin was prescribed for every patient at this training hospital were investigated. We determined the appropriateness of Caspofungin use in terms of right indication, right dose, right duration and right monitoring by comparison with Sanford and IDSA Guidelines. SPSS version 18.0 software was used for data analysis. The categorical data were shown in the form of frequency and percentage. There was no previous work of research compatible to our study, so no P value is presented as this study is merely descriptive. Also the numeric variables were reported as mean and standard deviation. Results Among 43 enrolled patients 21 subjects (48.8%) were male. The mean age was 50.1 ±20.4 years. The underlying diseases of the patients are shown in Table 1. Table 1. Underlying disease in patients receiving Caspofungin Underlying disease Frequency Percent