Assessment of Open Formulary Policy on Voriconazole

SOPHEA KOY, PharmD,CLAUDE A. TONNERRE, MD, MATTHEW H. SAMORE,

Author address: 

Univ. of Utah, Salt Lake City, UT and JENNY C. LO, PharmD, Univ. of Utah Hosp., Salt Lake City, UT

Abstract: 

Background: University of Utah Hospital Pharmacy and Therapeutics Committee approved the unrestricted use of voriconazole for serious fungal infections for a trial period of 12-months. This study attempts to evaluate the use of voriconazole during this period and whether restrictions should be applied in the future. Methods: From May 2002 to April 2003, hospitalized patients at University of Utah Hospital who received voriconazole were included. Medical records were reviewed. An Infectious Disease (ID) fellow was then asked to assess if voriconazole use would be approved if it is restricted. Results: Twenty-six patients received voriconazole over the one year period, 15 (58%) were male, and median age was 51 years (17-84 years). Median treatment duration 22 days (1-42 days); median hospital stay 36 days (2-69 days). Twenty-four (92%) patients were immunocompromised. Six (23%) patients received voriconazole for an FDA approved indication of pulmonary aspergillosis [1-A.ustus, 1-A.terreus, 1-A.fumigatus, 3-presumed]; 11 (42%) other documented fungal infections [6-C.albicans, 6-C.glabrata, 1-Alternaria, 1-Penicillium sp., 1-Scopulariopsis brumptii]; 5 (19%) for highly suspected fungal infections; and 4 (15%) inappropriately for fungal prophylaxis. ID would have approved 16/26 (62%) requests for voriconazole use. Five (19%) of patients received concurrent antifungal therapy of either amphotericin or caspofungin. Four (15%) patients had documented adverse drug reactions: 2 increase in LFTs, 1 rash, and 1 visual disturbance. Almost all patients were appropriately monitored for drug-drug interactions. Conclusions: Our findings suggest that voriconazole use should be restricted. Only a quarter of the patients received voriconazole for labeled use and up to 38% of voriconazole use may be inappropriate. Many prescribers need assistance in selecting the optimal antimicrobial therapy. Despite protests from prescribers who favor education over restriction, our experience demonstrates the use of voriconazole without restrictions cannot be justified.
2003

abstract No: 

NULL

Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st