The antifungal pipeline for invasive fungal diseases: what does the future hold?

Introduction: Over the last two decades, we have experienced pressing needs for new additions to the antifungal armamentarium given the emergence of resistant fungi, the growth of at-risk patient populations for invasive fungal diseases (IFD), the high morbidity and mortality associated with IFD.

Areas Covered: The current review will discuss the five promising antifungal agents for IFD (i.e.

The 2018 Aged Care National Antimicrobial Prescribing Survey: results show room for improvement.

The annual Aged Care National Antimicrobial Prescribing Survey aims to identify local and national prescribing issues and guide antimicrobial stewardship goals In the 2018 point prevalence survey, medication charts of over 20,000 residents were reviewed from 407 participating facilities across Australia On the day of the survey, almost 10% of residents were prescribed an antimicrobial Nearly two-thirds of recently prescribed antimicrobials were for residents who had no documented signs or symptoms of infection Over a quarter of antimicrobials had been prescribed for longer than six months Incomplete documentation was a prominent barrier to proper review of antimicrobial therapy, with the indication, review date or stop date not documented for many prescriptions Recommendations include using appropriate microbiological testing to guide prescribing, following national antimicrobial prescribing guidelines, documenting the indication for the antimicrobial, and its start, stop and review dates, and monitoring and re-evaluating long-term antimicrobial use

Meeting the challenge for effective antimicrobial stewardship programs in regional, rural and remote hospitals - what can we learn from the published literature?

Introduction: Antimicrobial resistance (AMR) has been recognised as an urgent health priority, both nationally and internationally. Australian hospitals are required to have an antimicrobial stewardship (AMS) program, yet the necessary resources may not be available in regional, rural or remote hospitals. This review will describe models for AMS programs that have been introduced in regional, rural or remote hospitals internationally and showcase achievements and key considerations that may guide Australian hospitals in establishing or sustaining AMS programs in the regional, rural or remote hospital setting.

Safe disposal of prescribed medicines.

The National Return and Disposal of Unwanted Medicines Program provides a free and safe method for the disposal of unwanted and expired medicines. This stops drugs being dumped in landfill and waterways. An audit showed that over 600 tonnes of medicines are returned through the program.

Pharmacoeconomic evaluation of voriconazole vs. liposomal amphotericin B in empiric treatment of invasive fungal infections in Turkey.

Background: Invasive fungal infections (IFI) are associated with considerable expense and mortality on healthcare systems. There is a need to provide evidence of both clinical efficacy and value for money with any health technology. The current pharmacoeconomic evaluation investigated the use of liposomal amphotericin B (LAmB) and voriconazole for the empiric treatment of IFI in the Turkish setting.

Utility of bronchoalveolar lavage fluid galactomannan alone or in combination with PCR for the diagnosis of invasive aspergillosis in adult hematology patients: a systematic review and meta-analysis.

Background: The clinical utility of bronchoalveolar lavage (BAL) fluid galactomannan (GM) for the early diagnosis of invasive aspergillosis (IA) varies widely across studies mainly due to heterogeneity of the studied populations.

Methods: We conducted a systematic review and meta-analysis of 16 studies involving 783 adults with hematological malignancies to derive summary estimates of the overall accuracy of BAL-GM for diagnosing IA.

Findings: Summary estimates of BAL-GM using an optical density (OD) index cutoff value of 1.

Drug-related problems detected in Australian Community Pharmacies: The PROMISe Trial.

Background: Drug-related problems (DRPs) are a major burden on health care systems. Community pharmacists are ideally placed to detect, prevent, and resolve these DRPs.

Objective: To determine the number and nature of DRPs detected and clinical interventions performed by Australian community pharmacists, using an electronic system.

Identification by observation of clinical pharmacists' activities in a hospital inpatient setting.

Unlabelled: The aim of the study was to quantify clinical pharmacists' workload in Australia. Specific objectives were to perform a direct observation of the pattern of clinical activities in two acute hospitals and compare that with previously documented self-reported patterns. We were also interested in identifying what records kept by pharmacists would capture all the activities they perform.

Development and validation of the medication-based disease burden index.

Background: Medication lists offer an alternative source of data on comorbidities and disease burden.

Objective: To develop and validate the Medication-Based Disease Burden Index (MDBI).

Methods: A list of medications corresponding to the leading causes of global death was pilot tested and finalized by an expert panel.