Antifungal stewardship considerations for adults and pediatrics

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Antimicrobial Stewardship

Background:

• Rising incidence of invasive fungal infections (IFI) in immunocompromised populations necessitates optimized antifungal use.
• Challenges in IFI diagnosis contribute to treatment delays and adverse outcomes.
• Emerging data link antifungal exposure and suboptimal dosing to antifungal resistance, particularly in Candida species.

Purpose of the Study:

• To outline coordinated interventions for monitoring and directing appropriate antifungal agent use.
• To minimize selective pressure and adverse events associated with antifungal therapy.
• To improve clinical outcomes for patients with invasive fungal infections.

Main Methods:

• Implementation of multi-pronged bundle approaches within antimicrobial stewardship programs.
• Utilizing post-prescription review and feedback mechanisms.
• Employing prior authorization for antifungal agents.
• Developing institutional guidelines for diagnostic testing, agent selection, dosing, duration, therapeutic drug monitoring, and de-escalation strategies.

Main Results:

• Coordinated interventions aim to ensure suitable prescribing of antifungals.
• Strategies address appropriate choice, dose, and duration of antifungal therapy.
• Focus on de-escalation and intravenous-to-oral conversion to optimize treatment.

Conclusions:

• Antifungal stewardship is crucial for managing IFI in at-risk populations.
• Structured stewardship programs can enhance appropriate antifungal utilization.
• Effective stewardship practices contribute to better clinical outcomes and reduced antifungal resistance.