Please cite this article in press as: Poulat C, et al. Assessment of high-priced systemic antifungal prescriptions. Med Mal Infect (2017), http://dx.doi.org/10.1016/j.medmal.2017.03.004 ARTICLE IN PRESS +Model MEDMAL-3813; No. of Pages 7 Disponible en ligne sur ScienceDirect www.sciencedirect.com Médecine et maladies infectieuses xxx (2017) xxx–xxx Original article Assessment of high-priced systemic antifungal prescriptions  Évaluation des pratiques cliniques de prescription des antifongiques systémiques coûteux C. Poulat a , Y. Nivoix a,∗ , A. Launoy b , P. Lutun c , P. Bachellier d , S. Rohr d , M.-L. Woehl d , D. Levêque a , V. Bru e , R. Herbrecht f , B. Gourieux a a Pharmacy, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France b Surgical Intensive Care Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France c Medical Intensive Care Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France d Hepatobiliary, Pancreatic and Digestive Surgery Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France e Institut de parasitologie et de pathologie tropicale, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France f Oncology and Hematology Department, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67098 Strasbourg, France Received 8 January 2016; received in revised form 17 June 2016; accepted 10 March 2017 Abstract Objectives. – To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. Methods. – Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. Results. – Seventy-four treatments were analyzed. Treatments were prescribed for prophylactic (1%), empirical (22%), pre-emptive (16%), or targeted therapy (61%). Caspofungin accounted for 68% of prescriptions, followed by voriconazole (20%) and liposomal amphotericin B (12%). Indication was appropriate in 91%, debatable in 1%, and inappropriate in 8%. Dosage was appropriate in 69%, debatable in 8%, and inappropriate in 23%. Prescriptions were inappropriate for the following reasons: lack of dosage adjustment in light of the hepatic function (10 cases), underdosage or excessive dosage by > 25% of the recommended dose in seven cases. De-escalation to fluconazole was implemented in 40% of patients presenting with a fluconazole-susceptible candidiasis. Conclusion. – The overall incidence of appropriate use was higher in 2012 compared with 2007 (62% and 37% respectively, P = 0.004). Nevertheless, costly antifungal prescriptions need to be optimized in particular for empirical therapy, dosage adjustment, and potential de-escalation to fluconazole. © 2017 Elsevier Masson SAS. All rights reserved. Keywords: Aspergillosis; Candidiasis; Antifungal therapy Résumé Objectifs. – Évaluer le respect des bonnes pratiques cliniques de prescription d’antifongiques coûteux en conformité avec les recommandations internationales et comparer ces résultats à une première enquête réalisée en 2007. Méthode. – Étude rétrospective incluant toutes les prescriptions d’antifongiques coûteux dans un service de réanimation médicale, de réanimation chirurgicale et de chirurgie digestive, endocrinienne et hépatique. L’évaluation a porté sur les critères suivants: indication, posologie et désescalade. Résultats. – Soixante-14 antifongiques coûteux ont été prescrits. Les types de traitements étaient: prophylactiques (1 %), empiriques (22 %), pré-emptifs (16 %) et curatifs (61 %). La caspofungine était prescrite dans 68 % des cas, suivie du voriconazole (20 %) et de l’amphotéricine  This study was presented as a poster at the 42nd ESCP Symposium on Clinical Pharmacy, 16–18 October, Prague. ∗ Corresponding author. Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France. E-mail address: yasmine.nivoix@chru-strasbourg.fr (Y. Nivoix). http://dx.doi.org/10.1016/j.medmal.2017.03.004 0399-077X/© 2017 Elsevier Masson SAS. All rights reserved.