In our thesis, we have focused on the protocol of treating diseases with systematic antifungal substances (Voriconazole, Micafungin, Anidulafungin, Caspofungin, Amphotericin B).
The policies of Murska Sobota General Hospital dictate that the doctor should fill out an order form for alternative antimicrobial medications before prescribing said medication. Our research included all patients who were issued the order form during a period between 1st January 2015 and 31st December 2017 and were given some of the previously mentioned substances. Our research sample included 51 patients. Based on the information we gained from the order forms, we were able to access their medical papers and other hospital documents.
We were interested in the frequency of medication use as well as the most common agents and risk factors for contagion. While evaluating the treatment protocol, we observed various aspects (the diagnostic procedures carried out, laboratory and clinical results, the timeline of the treatment, how the medication was administered, the costs, etc.). We considered the accompanying therapy and the occurrence of potential interactions. Our primary goal was to point out the possible improvements of the treatment results and to define what role a clinical pharmacist has within this process.
We established that 80,4% of patients were on the intensive care unit at least once during their hospitalisation. The most commonly prescribed antifungal substance was Micafungin (56,9%). The most commonly contracted species was the Candida albicans (37,9%). We established that improvement is possible in the following areas: (i) testing the sensitivity of insulators for antifungal substances (AS), (ii) choosing the most suitable AS and transitioning to treatment with Fluconazole, (iii) recognizing the restrictions and selections of diagnostic procedures, (iv) the frequency of monitoring the response to antifungal therapy, (v) the ways of administering AS, especially to overweight patients and those with kidney and liver dysfunction. Within a high percentage of patients with polypharmacy (98%), we recognized the need for clinically important potential interactions in 60,8% of patients. We estimated that the costs of an individual drug therapy would range mostly (41,2%) between 1.000 and 3.000 €. During treatment, a clinical pharmacist took part in 31,4% of the analysed examples.
With this data, we have shown that concrete improvements are possible when it comes to treating patients. We have also recognized several areas in which the presence of a clinical pharmacist can contribute to these improvements.
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