Abstract：
A loading dose of voriconazole (VRCZ) is recommended to increase its blood concentration at an early stage. However, the trends in the implementation of the loading dose in VRCZ in Japan has not yet been clarified. In addition, although pharmacists play many important roles in antimicrobial stewardship, the effect of pharmacist intervention on the implementation of a loading dose of VRCZ has not yet been reported. Therefore, this study aimed to clarify the implementation of loading dose of VRCZ and the influencing factors of loading dose. This study used an administrative claims database that included patients who received injectable VRCZ between 2010 and 2019. The implementation of loading doses in the VRCZ was evaluated annually. Multivariate logistic regression analysis was performed to identify the factors influencing loading dose. Overall, 2197 patients were included. The implementation rate of the loading dose remained below 65% throughout the study period. Among medical fees that can be calculated through pharmacist intervention, only the infection prevention and control premium significantly increased the implementation of loading dose of VRCZ (odds ratio: 1.587, 95% confidence interval: 1.053-2.392). In conclusion, antifungal stewardship may have been promoted at medical institutions that established infection prevention and control. In the future, pharmacists will need to intervene more actively from the beginning of VRCZ administration.
摘要：
建议使用伏立康唑（VRCZ）的负荷剂量在早期增加其血液浓度。然而,日本VRCZ实施负荷剂量的趋势尚未明确.此外,虽然药剂师在抗菌药物管理中发挥着许多重要作用，药剂师干预对实施VRCZ负荷剂量的影响尚未报道.因此,本研究旨在阐明VRCZ负荷剂量的实施及负荷剂量的影响因素。这项研究使用了一个行政索赔数据库，其中包括2010年至2019年期间接受可注射VRCZ的患者。每年评估VRCZ中负荷剂量的实施情况。采用多因素logistic回归分析确定负荷剂量的影响因素。总的来说,包括2197名患者。在整个研究期间,负荷剂量的执行率保持在65%以下。在可以通过药剂师干预计算的医疗费用中，只有感染预防和控制费用显着增加了VRCZ的实施负荷剂量（比值比：1.587，95％置信区间：1.053-2.392）。总之,抗真菌管理可能已经在建立感染预防和控制的医疗机构得到了推广。在未来,从VRCZ给药开始,药剂师就需要更积极地进行干预.
