Pharmacoepidemiology of Antifungal Drugs in 16 French Neonatal Intensive Care Units

Background: Invasive candida infection is a devastating condition amongst very and extremely preterm infants cared for in NICUs. Fluconazole (FC) is the most widely used antifungal medication in neonatology for both prophylactic and curative treatment of candida infections (invasive or local). Point prevalence surveys have shown that FC is frequently underdosed in NICUs (Lestner 2015 Antmicrob., Chemother, 2015) a condition favouring a loss of efficacy and increased mortality.

Objective : We hypothezised that a computerized prescribing order entry (C.P.O.E.) system could allow preselected prescription of antifungal drugs and should make doctors more compliant with professional recommendations even though the prescriber always has the final decision.

Methods: Sixteen NICUs used the same C.P.O.E. system for all neonatal prescriptions. All prescriptions were made anonymous monthly and exported in a common database.

Results : Population : 13135 newborns : 998 were administered antifungal drugs. Overall, 273 patients were given a curative antifungal medication for invasive infection (57 after prophylaxis and 5 after an orodigestive infection) ; 588 were given prophylaxis (FC or nystatin) ; 194 were given orodigestive/local treament.

Table shows that the lower the GA the higher the rate of antifungal treatment.

Fluconazole was more prescribed (59%) than Nystatin, the different forms of Amphotericin B, caspofungine, flucytosine, mycafungine and miconazole. Amongst the 350 patients administered prophylactic Fluconazole the rate of underdosage was 0% and the rate of overdosage was 7.4 %.

Conclusion: This pharmaco- epidemiological study shows the possibility of assisting prescribers in the choice of the right doses in the case of antifungal drugs.