410. Impact of Pediatric Antifungal Adverse Drug Reactions on Prescribing Practices

Abstract

BackgroundWhile antibiotics frequently cause adverse drug reactions (ADR), the rate of antifungal (AF) ADR is unknown. The mechanisms of AF ADR and cross-reactivity among a drug class (i.e., azoles) are poorly understood. Given the use of AF therapy is on the rise, it is important to better understand the prevalence of AF ADR and how these reactions influence prescribing.MethodsThirty-two hospitals participated in a quarterly pediatric point prevalence survey that documented details on all admitted patients 0–17 years receiving any systemic antimicrobials, including drug, dose, and documented history of an antimicrobial ADR between June 2016 and December 2017. Patients who were recorded as receiving at least one systemic AF were included. A comparison of AF prescribing practices between those with and without an AF ADR was performed.ResultsAmong 13,179 total patients, 2,213 AF were prescribed to 2,101 unique patients. The most common indications for AF included prophylaxis (64%), fever with neutropenia (4%), neonatal sepsis (3%), and catheter-related bloodstream infection (3%). The prevalence of patients with any documented AF ADR was 2.9%. Amphotericin was most commonly associated with an ADR. Fluconazole was the most commonly prescribed AF in those with no ADR (49%) when compared with those with an AF ADR (13%; P < .05). Patients with an amphotericin ADR were more likely to receive voriconazole (29%) when compared with those without (15%; P < .05). Interestingly, posaconazole use was highest in those with an azole ADR (22%) when compared with those with no azole ADR (4%; P < .05). Echinocandin ADR were infrequent, and those with a reported ADR still received an echinocandin 62% of the time.ConclusionSignificant differences in antifungal prescribing exists based on ADR status. More work is needed to be able to effectively classify AF ADR, determine safe prescribing practices in those with an AF ADR, and evaluate outcomes associated with AF ADR status. Disclosures All authors: No reported disclosures.