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.

• Preface

  F. Kate Gould; Russell E. Lewis; Malcolm D. Richardson

• The current treatment landscape: candidiasis

  Matteo Bassetti; Maddalena Peghin; Jean-Francois Timsit

• The current management landscape: aspergillosis

  Johan A. Maertens; Ola Blennow; Rafael F. Duarte; Patricia Muñoz

• An introduction to antifungal stewardship

  Malcolm D. Richardson

• The current treatment landscape: other fungal diseases (cryptococcosis, fusariosis and mucormycosis)

  Olivier Lortholary; Mario Fernández-Ruiz; John R. Perfect

• The role of the multidisciplinary team in antifungal stewardship

  Samir Agrawal; Rosemary Barnes; Roger J. Brüggemann; Riina Rautemaa-Richardson; Adilia Warris

• Conclusion and future perspectives on antifungal stewardship

  Jose María Aguado; Jose Tiago Silva; Emilio Bouza

• The current treatment landscape: the need for antifungal stewardship programmes

  Patricia Muñoz; Emilio Bouza; on behalf of the COMIC (Collaboration Group on Mycosis) study group