Prescribing Pattern of Antifungal Agents for Superficial Fungal Infection at a District Hospital

Abstract

Ketoconazole is well known antifungal drug associated with potential risk of liver injury. Due to this side effect, oral ketoconazole has been withdrawn from the markets in several countries. This study aims to describe pattern of oral antifungal drug prescriptions including ketoconazole, itraconazole, fluconazole and griseofulvin for treatment of superficial fungal infections and pattern of liver function monitoring at a District Hospital. These four drugs are listed in hospital formulary of the study hospital. Methods: Outpatient medical records of the year 2011 to 2015 were reviewed. The study included patients 15 year of age or older who received the study antifungal drugs for treatment of superficial fungal infections. In case of patients who had more than one time of treatment since the first date of study period, only the first treatment course was considered. Patients who had history of tuberculosis and patients whose interested variables were not available were excluded.  Study variables included gender, age, payment scheme, history of alcohol drinking, history of liver disease, underlying diseases, previous use of oral antifungal drugs, treatment indication, dose in unit of defined daily dose (DDD), duration, drug-drug interactions, liver function monitoring and abnormality. Descriptive statistics were used to describe characteristics of study samples, prescribing pattern, and liver function monitoring. Results: Of all 227 studied patients, their average age was 51.6 years. The most common prescribed drugs were griseofulvin (44.1%) and ketoconazole (40.1%). Ketoconazole was commonly prescribed for treatment of tinea cruris/corporis (n= 23) and onychomycosis (n= 22). Griseofulvin was major prescribed for treatment of onychomycosis (n= 56). Treatment indication with highest volume and longest duration of use of ketoconazole (42 DDD, 28.5 days) and griseofulvin (141 DDD, 143.5 days) was onychomycosis. Proportions of patients who were monitored for liver function within one week before treatment, during treatment, and within 3 months after drug discontinuation were 5.7%, 9.3%, and 7.1%, respectively. Conclusion: Ketoconazole and griseofulvin were the most common antifungal drugs used for superficial fungal infection. Treatment indication which was potential to expose high volume of drugs and long term used was onychomycosis. Liver function monitoring was rarely performed. Due to potential risk of hepatotoxicity, clinical guideline for prescribing ketoconazole should be revised.