Antifungal Stewardship

Antifungal stewardship (AFS) aims to preserve the future effectiveness of antifungal agents. It has features and challenges that are unique to antifungal agents namely:

  • high fatality rates
  • high drug costs
  • the development of antifungal resistance
  • complexity of fungal diseases in different patient populations
  • requirement for more aggressive management for malignant & inflammatory conditions
  • relative ease of prescribing the newer antifungal srugs due to:
    • reduced toxicity
    • emerging resistance
  • vulnerability and complexity of patient populations:
    • very low birthweight infants
    • children with genetic susceptibility to infection
    • patients treated with chemotherapy for malignant diseases
    • transplant patients
    • patients with chronic lung disease
    • patients depending on long term critical care

How then do clinicians deliver AFS?

The Steering Committee of the Continuing Antifungal Research and Education (CARE) Programme, organized and funded by Gilead Sciences Europe Ltd, selected this as a topic for the eighth CARE meeting, held in Madrid in November 2015. A primary goal of this meeting was to bring together infectious disease clinicians, medical microbiologists, medical mycologists, haematologists, pharmacologists and others to participate in a series of lectures, clinical case presentations and debate. A series of reviews (below) have been published this Supplement of the Journal of Antimicrobial Chemotherapy and reflect a cross-section of the key information presented.