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British Journal of Healthcare and Medical Research - Vol. 12, No. 02

Publication Date: April 25, 2025

DOI:10.14738/bjhmr.1202.18505. Gebremariam, S. T., Abafita, R. N., Fentaw, D. M., Telila, E. K., Jeldu, H. A., Mulugeta, B. A., Woldie, B. G., Baissa, M. T., Wollel, M.

M., Mandefro, B. T., Azale, A. W., & Tollosa, T. C. (2025). Assessment of Anti-fungal Drugs Utilization Pattern Among Patients

Attending at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, 2022. British Journal of Healthcare and Medical Research, Vol -

12(02). 229-241.

Services for Science and Education – United Kingdom

Assessment of Anti-fungal Drugs Utilization Pattern Among

Patients Attending at Zewditu Memorial Hospital, Addis Ababa,

Ethiopia, 2022

Samrawit Teame Gebremariam**

Department of Medicine, Zewditu Memorial Hospital,

Addis Ababa, Ethiopia

Robel Nasser Abafita

Department of Medicine, University of Gondar,

College of Medicine and Health Science

Dagmawi Mulugeta Fentaw

Department of Medicine, Jimma University,

Oromia Region, Ethiopia

Eden Kebede Telila

Department of Medicine, Jimma University,

Oromia Region, Ethiopia

Hosaena Alemayehu Jeldu

Department of Medicine,

Bethel Medical College Addis Ababa, Ethiopia

Betelhem Alemu Mulugeta

Department of Medicine, Debre Tabor University,

College of Health Sciences, School of Medicine

Biruk Getachew Woldie

Department of Medicine, Mekelle University,

College of Health Science, Mekelle, Ethiopia

Meron Tafa Baissa

Department of Medicine: University of Gondar,

College of Medicine and Health Science

Mekdes Molla Wollel

Department of Medicine, University of Gondar,

College of Medicine and Health Science

Bethel Tadesse Mandefro

Department of Medicine, University of Gondar,

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British Journal of Healthcare and Medical Research (BJHMR) Vol 12, Issue 02, April-2025

Services for Science and Education – United Kingdom

College of Medicine and Health Science

Abrham Workineh Azale*

Department of Medicine, Addis Ababa University,

College of Medicine and Health Science, Addis Ababa,

Ethiopia

Tewodros challa Tollosa*

Department of Medicine,

Jimma University Oromia Region, Ethiopia

ABSTRACT

Background: the inappropriate use of anti-fungal agents can cause adverse events,

toxicity, unnecessary exposure and cost, and increased microbial resistance, which

has important implications for morbidity and mortality. With a lack of adequate

Information on how drugs are being prescribed and utilized, it is almost impossible

to initiate a discussion on rational drug use or improvement on prescription habits

and developing practical guidelines. Drug utilization might not necessarily provide

answers on its own, but it contributes to rational drug use.Objective: To Assess anti- fungal agent utilization patterns among patients attending Zewditu Memorial

Hospital, Addis Ababa, Ethiopia, 2022. Methodology: A Retrospective Cross- sectional study design was used. Data regarding patient characteristics,

medications, diagnosis, dose and type of anti-fungal agent used were collected using

data abstraction forms by reviewing the patient's medical card and medication

charts. The data was entered into the SPSS 21 version for analysis. The analyzed

data was interpreted and presented in charts, graphs and tables. Results: 124 anti- fungal agents were prescribed to 75 patients. Female patients received (n=66,

53.23%) of these prescriptions, and Male patients received (n=58,

46.77%).patients who were under 18 years old received (n=100, 80.6%), and

patients who were 18 years old and above received (n=24, 19.3%).In this study,

prescription of Fluconazole was(n=54, 44.4%) and Ketoconazole (n=55, 43.5%)

while Clotrimazole was(n=9, 7.3%) and Terbinafine(n=6, 4.8%).the fungal infection

of this patients were tinea capitis (n=48, 64%,) tinea unguium (n=13, 17.3%),tinea

corporis(n=6, 8%)tinea pedis(n=7, 9.3%) tinea barbea (n=1, 1.3%). Conclusion:

This study finding shows that Fluconazole was the most common anti-fungal drug

prescribed orally, similar to elsewhere. However, oral Fluconazole was closely

followed by Ketoconazole, which was the most frequently prescribed drug topically.

This differed from other studies, meaning Clotrimazole was the most prescribed

drug topically anti-fungal in different countries. Lastly, most studies support that

Combination therapy of antifungals was more likely than Monotherapy.

Keywords: Anti-fungal, Utilization Pattern, Fungal infection

INTRODUCTION

Background of the Study

Fungal infections could be categorized as superficial, affecting the specificity of the skin, nail,

hair, or mucous layer, or systemic. It is most likely occurring in immunocompromised

individuals like those with AIDS more frequently (1). Anti-fungal agents are medicines that

stop the growth of or kill fungal pathogens that cause infections from a host with minimal

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Gebremariam, S. T., Abafita, R. N., Fentaw, D. M., Telila, E. K., Jeldu, H. A., Mulugeta, B. A., Woldie, B. G., Baissa, M. T., Wollel, M. M., Mandefro, B.

T., Azale, A. W., & Tollosa, T. C. (2025). Assessment of Anti-fungal Drugs Utilization Pattern Among Patients Attending at Zewditu Memorial Hospital,

Addis Ababa, Ethiopia, 2022. British Journal of Healthcare and Medical Research, Vol - 12(02). 229-241.

URL: http://dx.doi.org/10.14738/bjhmr.1202.18505.

toxicity to the host. Anti-fungal drugs can be classified into three main groups according to their

site of action. These are azoles, 5-fluorocytosi, and polyenes (2).

The indiscriminate use of these drugs results in undesirable side effects, drug interactions,

ecological disturbances, and difficulties in diagnosis. In addition, problems such as improper

storage, distribution, compliance, and selection of drugs constitute the main threat to society

(3). Rational use of medicines /drugs is defined as "patients receive medications appropriate

to their clinical needs, in doses that meet their requirements, for an adequate period, and at the

lowest cost to them and their community” (4).

In 1997, the World Health Organization (WHO) defined drug utilization as «the marketing,

distribution, prescription, and use of drugs in a society, with special emphasis on the resulting

medical, social and economic consequences» (5). Without the optimum data on how drugs are

being distributed, prescribed, and use of drugs in society and utilized, it's hard to initiate a

discussion on rational drug use or improvement of prescribing habits. Drug utilization might

not necessarily provide answers, but it contributes to the practice of rational drug use (6).

Drug utilization also involves differentiating good prescribing practices from bad prescribing

practices, encouraging rational prescribing, assisting in solving problems related to drug

therapy, providing Information to various authorities about drug-related misdeeds, and

assisting in framing a drug or health policy (7).

Statement of the Problem

Fungal infections in humans are considered life-threatening and have unfortunate health

consequences (8). Some fungal infections are superficial, affecting the skin, nails, hair, mucous

layer, or systemic. Even though systemic infections are found to be more life-threatening,

superficial infections are considered essential because their existence is epidemiologically

widespread (9).

Each year, over one billion people of all ages are affected by fungal infections across the globe

(10). Estimates over 1.6 million deaths and influence undesirable clinical outcomes and fatal

outcomes of several diseases (11). This figure is three times higher than the yearly passing from

malaria and equivalent to the rate of tuberculosis deaths per year (12).

The incidence of fungal infections is increasing rapidly and becoming a challenge to the

healthcare system. The growing population of immunocompromised individuals and the

change in medical practice pose contributing factors (13). Human immunodeficiency virus

(HIV), cancer, organ transplant, and other diseases are major contributing factors to the

increase of this incidence. Approximately there are 38 million (HIV)-infected people across the

globe. With a total population of 1.3 billion, Africa accounts for 75% of HIV-positive people in

the world (14). In particular, Africa takes up to approximately 50% of all fungal-related passing

as a consequence of HIV infections. However, there is a lack of data accuracy (15).

Other contributing factors are the indiscriminate use of broad-spectrum antimicrobials and

aggressive treatment of malignant diseases. Moreover, mild to moderate fungal infections, such

as superficial and subcutaneous fungal infections affecting the skin, are common in the

community, even among people with no known immune deficiency disease (16).