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Journal of Antimicrobial Chemotherapy (2001) 48, 303-310
© 2001 The British Society for Antimicrobial Chemotherapy

Antimicrobial practice

Use of fluconazole in daily practice: still room for improvement

S. Natscha,b,*, M. H. M. Steeghsc, Y. A. Heksterb, J. F. G. M. Meisd,{dagger}, J. W. M. van der Meera and B. J. Kullberga

a Departments of General Internal Medicine, b Clinical Pharmacy and d Medical Microbiology, University Medical Center, Nijmegen, The Netherlands; c Pharmacy Department, Eemland Hospital, Amersfoort, The Netherlands

One hundred courses of fluconazole treatment in a university hospital and 81 courses in a non-university teaching hospital have been analysed in a prospective audit to evaluate prescribing practices. The quality of treatments was assessed by an infectious disease specialist and a pharmacist according to standard guidelines. In the non-university hospital, prescribed dosages were lower than in the university hospital, and often below the recommended dose. Mean duration of treatment for oesophageal candidosis and disseminated infections was considerably shorter in the non-university hospital compared with the university hospital, and often judged too short. Microbiological samples were examined in 75% of the cases in both hospitals. The expert reviewers agreed with the indication to use fluconazole in 58–100% of cases in the university hospital and 42–80% in the non-university hospital, depending on the type of infection. There did not appear to be a major problem with inappropriate use of fluconazole. However, important issues for improvement could be identified, such as increasing the dosage and duration of treatment in cases of serious infections, and withholding treatment from patients with colonization rather than infection.

* Correspondence address. Department of Clinical Pharmacy, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31-24-3616405; Fax: +31-24-3540331; E-mail: S.Natsch{at}klinfarm.az.nl

{dagger} Present address. Department of Medical Microbiology and Regional Laboratory for Public Health, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands


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