Global Divergence of Antifungal Prescribing Patterns. Data from the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children Surveys

Laura Ferreras-Antolin*, Julia Bielicki, Adilia Warris, Mike Sharland, Yingfen Hsia

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: 

Globally, invasive fungal diseases (IFDs) have a significant impact in human health. With an increasing pediatric population at risk of IFD, effective antifungal drugs access and affordability should be ensured universally. The aim of our study was to characterize the global antifungal drug use in neonates and children and its variability between countries in different income groups.

Methods: 

Data were extracted from the Global Antimicrobial Resistance, Prescribing and Efficacy in Neonates and Children Point Prevalence Survey project, consisting in 1 pilot and four 1-day Point Prevalence Survey between 2015 and 2017. The data had been entered through a study-specific web-based data collection tool.

Results: 

From a total of 13,410 children included, 7.8% (1048/13,410) received at least 1 systemic antifungal drug: 9.5% (95% confidence interval: 8.9%-10.1%) in high income countries (HIC) versus 5.0% (95% confidence interval: 4.4%-5.6%) in low-middle income countries (LMIC) (P < 0.01). A significant proportion of patients on antifungals belonged to high-risk group for IFD (67.4%; 706/1048); most of these were managed in HIC (72.8%, P < 0.01). The likelihood of receiving antifungals being in high-risk group was higher in HIC compared with LMIC (ratio of 5.8 vs. 3.4, P < 0.01). Antifungal prophylaxis was more likely prescribed in HIC (67.2% vs. 30.4%, P < 0.01). Fluconazole was the most frequently prescribed drug. The proportional use of fluconazole was higher in LMIC compared with HIC. 

Conclusions: 

A significant variability of antifungal prescribing patterns was observed. The proportional use of systemic antifungals was twice as high in HIC compared with LMIC. More detailed data on access and antifungal use in limited-resource settings should be explored.

Original languageEnglish
Pages (from-to)327-332
Number of pages6
JournalPediatric Infectious Disease Journal
Volume40
Issue number4
DOIs
Publication statusPublished - 01 Apr 2021

Bibliographical note

Publisher Copyright:
© 2021 Institute of Electrical and Electronics Engineers Inc.. All rights reserved.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • antifungal
  • children
  • neonates
  • Point Prevalence Survey

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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