Title:Assessment of Antimicrobial Utilization among Cancer Patients with
Febrile Neutropenia at the Lebanese Hospitals
Volume: 18
Issue: 4
Author(s): Sarah Cherri*, Diana Malaeb*, Lamis Shouman, Iqbal Fahs, Rabih Hallit, Souheil Hallit, Bassem Malaeb and Pascale Salameh
Affiliation:
- School of Pharmacy, Lebanese International University, Mouseitbah, Beirut, Lebanon
- School of Pharmacy, Lebanese International University, Mouseitbah, Beirut, Lebanon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.
Keywords:
Antibiotic, antifungal, antiviral, febrile neutropenia, evaluation, hospital.
Abstract:
Background: Febrile neutropenia is a prevalent oncologic complication. Initiating rapid treatment
with empirical antimicrobials in febrile neutropenia patients reduces mortality due to infections.
Objectives: The study aims to evaluate antimicrobial utilization among FN patients in Lebanon in
terms of drug choice, dose, and duration of the treatment. This is a retrospective, multicenter, observational
study conducted at three different Lebanese university hospitals (in which the Infectious
Diseases Society of America (IDSA) guidelines are adopted), between February 2014 and
May 2017.
Methods: Adult cancer patients aged 18 years and older with febrile neutropenia were included in
the study. Using the IDSA guidelines as a reference, patients were assessed whether they received
the antimicrobial regimen inconsistent with the IDSA reference or not. Statistical analysis was performed
using the Statistical Package for the Social Science software (SPSS version 22.0).
The adherence to guidelines for the indication and doses of antibiotics and anti-fungal in patients
with febrile neutropenia.
Results: A total of 124 patients with a mean age of 54.43 ± 17.86 years were enrolled in the study.
Leukemia (29.7%) was the most prevalent cancer and the most common infection was sepsis
(20.2%). Combination antibiotic lactams are the most prescribed antibiotics (86.8%). Only 94
(86.23%) patients were given the antibiotic therapy appropriate for choice, dose, and duration.
Empirical antifungal therapy was initiated in 63.7% of the patients and fluconazole was the most
used antifungal (36.3%). In contrast to antibiotics, the majority of antifungal choices were not selected
according to the recommendations and they were considered inappropriate for doses and the
required treatment duration as proposed by (IDSA). Fifty-eight percent of patients received antivirals,
even though it is not recommended as empirical treatment.
Conclusion: In conclusion, this study reveals a non-consistent antimicrobial utilization practice at
the involved sites concerning FN treatment. Inappropriateness was encountered in drug selection,
dose, and duration of treatment with antifungals and antivirals.
