Does the current treatment of invasive fungal infection need to be reviewed?

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Antimicrobial Stewardship

Background:

• Invasive fungal infections (IFIs) incidence is increasing due to a growing population of immunocompromised patients.
• Advances in diagnostics and novel antifungal agents have improved IFI prognoses over the past decade.
• Antifungal consumption surged by 27% between 2007-2009, significantly outpacing antibacterial consumption.

Purpose of the Study:

• To evaluate the justification for the increased consumption of antifungals.
• To assess the optimal use of antifungals in clinical practice.
• To reconsider current treatment strategies for IFIs.

Main Methods:

• Review of scientific literature on antifungal indications.
• Analysis of antifungal consumption trends.
• Evaluation of evidence supporting antifungal prophylaxis, targeted therapy, and empirical therapy.

Main Results:

• Strong evidence supports antifungal prophylaxis and targeted therapy.
• Evidence for empirical antifungal therapy, the most common indication, is weak.
• Antifungals are associated with adverse effects, drug interactions, resistance, superinfections, and high healthcare costs.

Conclusions:

• The substantial increase in antifungal use warrants critical evaluation.
• Current antifungal prescribing practices may not be optimal.
• Revisiting IFI treatment paradigms is necessary to ensure appropriate and cost-effective care.