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Table 2 Antifungal Prescription Characteristics and Adequacy

From: Antifungal stewardship in a tertiary care paediatric hospital: the PROAFUNGI study

  Total Prophylaxis Treatment
Antifungal prescriptions, n 119 75 44
Indication for AF therapy
 Primary prophylaxis, n (%) 70 (58.8) 70 (93.3)  
 Secondary prophylaxis, n (%) 5 (4.4) 5 (6.7)  
 Empirical therapy, n (%) 30 (25)   30 (68.2)
 Pre-emptive therapy, n (%) 1 (0.8)   1 (2.3)
 Targeted therapy, n (%) 13 (11)   13 (29.5)
Underlying disease
 Cancer, n (%) 64 (54) 48 (64) 16 (36.4)
 HSCT, n (%) 43/64 (67) 35/48 (73) 8/16 (50)
 Critical paediatric patients, n (%) 29 (24) 16 (21.4) 13 (29.5)
 Critical newborns, n (%) 7 (6) 3 (4) 4 (9.1)
 Primary immunodeficiencies, n (%) 11 (9) 7 (9.3) 4 (9.1)
 Solid organ transplant, n (%) 3 (3) 0 (0) 3 (6.8)
 Other, n (%) 5 (4) 1 (1.3) 4 (9.1)
AF agent
 Liposomal amphotericin B, n (%) 55 (46.2) 41 (54.6) 14 (32)
 Posaconazole, n (%) 21 (17.7) 21 (28) 0 (0)
 Anidulafungin, n (%) 13 (10.9) 3 (4) 10 (23)
 Fluconazole, n (%) 12 (10.1) 6 (8) 6 (14)
 Micafungin, n (%) 6 (5.0) 2 (2.7) 4 (9)
 Isavuconazole, n (%) 5 (4.2) 0 (0) 5 (11)
 Voriconazole, n (%) 4 (3.4) 0 (0) 4 (9)
 Itraconazole, n (%) 2 (1.7) 2 (2.7) 0 (0)
 Caspofungin, n (%) 1 (0.8) 0 (0) 1 (2)
Antifungal prescription evaluations, n 219 144 75
 Non-optimal prescriptions, n (%) 24 (11) 12 (8) 12 (16)
 Unnecessary, n (%) 14 (6) 10 (7) 4 (5)
 Inappropriate, n (%) 2 (1) 0 (0) 2 (3)
 Inadequate Incorrect dose, n (%) 7 (3) 4 (3) 3 (4)
Incorrect route of administration, n (%) 0 (0) 0 (0) 0 (0)
Incorrect duration, n (%) 7 (3) 7 (5) 0 (0)
Disagreement with institutional protocol, when available, n (%) 12 (8)a 4 (3)a 8 (20)a
Non-optimal prescription distribution among underlying disease, n (%)
 Cancer 4 (16.7) 2 (16.7) 2 (16.7)
 HSCT, n (%) 4/4 (100) 2/2 (100) 2/2 (100)
 Critical paediatric patients, n (%) 14 (58.3) 8 (66.7) 6 (50)
 Critical newborns, n (%) 1 (4.2) 1 (8.3) 0 (0)
 Primary immunodeficiencies, n (%) 1 (4.2) 1 (8.3) 0 (0)
 Solid organ transplant, n (%) 1 (4.2) 0 (0) 1 (8.3)
 Other, n (%) 3 (12.5) 0 (0) 3 (25)
  1. Abbreviations: AF antifungal
  2. a Calculated as a percentage of the prescriptions for which a local institutional protocol was available: 157 total, 117 prophylaxis, 40 treatment
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