Antifungal products dispensed by a group of community pharmacies in south africa

Abstract

Background: There is increasing evidence of Candida species becoming resistant to some antifungal agents. It is therefore important to examine the current prescribing trends of antifungal agents in primary care. Objectives: To determine the prescribing patterns of antifungal products over 1 year as dispensed by a large South African community pharmacy group. Methods: A retrospective, cross-sectional drug utilization study was conducted on prescription data of a national community pharmacy group in South Africa for 2010. A total of 1,576,593 antimicrobial products were prescribed, of which anti-fungal products constituted 7.42%. Results: A total of 84,912 patients received 116,955 antifungal products during 2010. (Average 1.38; SD = 1.05). Most products dispensed were not repeat prescriptions (84.98%). Diagnosis codes were not specific (mostly ICD- 10 codes Z and U) and no seasonal trends in prescribing could be detected. The majority (70.86%) were prescription- only products (Schedule 4). Fluconazole was the most frequently prescribed active ingredient (4214%), followed by nystatin (28.83%) and itraconazole (15.33%). The average age of patients was 37.64 (SD = 18.29) years with patients between 20 and 49 years receiving 49.44% of the products. Female patients were prescribed more anti-fungal products (69.67%) than antimicrobials (58.32%). In the age group under 16 years, nystatin (53.07%) and griseofulvin (26.74%) were the most frequently dispensed. In the age group 65 years and older, fluconazole (44.26%) and nystatin (27.27%) were the most often dispensed. The average cost per anti-fungal product was R12319. Voriconazole products (22 prescriptions) were the most expensive (average of R8536.64). Nystatin-based products (mostly oral drops or oral suspensions) were on average the least expensive (R3913 per product). In general, most anti-fungal products were capsules (55.38%), followed by oral drops (22.34%). Conclusions: Fluconazole remained the most popular anti-fungal agent in primary care in South Africa. The need for diagnosis in databases is of critical importance to determine the cost of treating different types of fungal infections.