Assessment of Fluconazole Utilization: A Prospective Observational Study of Prescribing Patterns, Resistance Trends, and Empirical Therapy Outcomes in Hospitalized Patients at A Tertiary Care Hospital

Background

Fluconazole is a triazole antifungal extensively indicated for the treatment of Candida infections, particularly in hospitalized and immunocompromised patients. It exerts its action by inhibiting lanosterol 14-demethylase, thereby disrupting ergosterol synthesis and fungal cell membrane integrity. However, its widespread and prolonged use has contributed to the emergence of resistance, especially among non-albicans Candida species.

Objectives

This underscores the importance of rational drug utilization and continuous evaluation of prescribing patterns.

Materials and Methods

This study is designed to systematically evaluate the utilization patterns of fluconazole in a tertiary care hospital setting. It focuses on assessing prescribing patterns, dose optimization and adherence to evidence-based guidelines. Additionally, the study aims to analyze antifungal resistance trends among Candida isolates and to correlate these findings with clinical outcomes. The results are intended to support optimized clinical decision-making and promote rational antifungal therapy. This study aimed to evaluate the prescribing patterns of fluconazole in a tertiary care hospital, assess resistance trends among Candida isolates in invasive candidiasis, and determine the clinical effectiveness of empiric therapy, including treatment outcomes, and breakthrough infections. A drug utilization study of fluconazole was conducted by using prospective observational design from November 2024 to July 2025 at Deenanath Mangeshkar Hospital, Maharashtra.

Results

A total of 180 hospitalized patients undergoing antifungal therapy were enrolled. The collected variables included demographic characteristics, clinical indications, antifungal treatment modality (empirical or targeted), dosage regimen, formulation, duration of therapy, renal function assessment via creatinine clearance, site of fungal isolation, and antifungal susceptibility profiles. Data was analyzed using Microsoft excel software. Prescribing patterns were evaluated using standard Drug Utilization Review (DUR) indicators to assess therapeutic appropriateness and adherence to evidence-based clinical practices. Among 180 patients receiving fluconazole, Candida tropicalis (30%) and Candida glabrata (16.67%) were prominent resistant species. Male patients (59.4%) and age ≥ 60 years (52.8%) were most affected. Empirical therapy accounted for 50% with 14.4% resistance. Candida tropicalis (30%) and Candida auris (20%) were frequent isolates, mainly from urine (57%) Fluconazole use was highest in immunocompromised patients (84%), minimal in those with invasive devices (1%) and withheld in (15%) due to resistance.

Conclusion

Early and accurate mycological diagnosis, in conjunction with routine antifungal susceptibility testing, is fundamental for optimizing the clinical use of fluconazole. Timely identification of fungal pathogens and their susceptibility profiles enable precise selection of antifungal therapy and supports early de-escalation to targeted treatment approaches. This strategy reduces unnecessary empirical exposure to antifungal agents, minimizes the risk of adverse drug reactions, and enhances therapeutic efficacy. In addition, continuous monitoring of antifungal prescribing patterns and resistance trends is crucial to ensure judicious fluconazole utilization in healthcare settings. Implementation of evidence-based treatment protocols and microbiological surveillance may further aid in reducing the emergence and spread of fluconazole-resistant fungal isolates. Collectively, these measures contribute to improved patient outcomes and the preservation of antifungal effectiveness in clinical practice.