Antifungal prophylaxis and pre-emptive therapy: When and how?

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Hematology

Background:

• Critically ill and immunocompromised patients face increased risk of invasive fungal infections (e.g., Aspergillus, Candida, Pneumocystis jirovecii).
• Prophylactic and pre-emptive antifungal strategies are implemented for high-risk populations, necessitating a balance between risk reduction and potential harm.

Purpose of the Study:

• To review evidence on the advantages and disadvantages of antifungal prophylaxis and pre-emptive treatment.
• To discuss current strategies in various patient groups, including those with malignancies, post-surgery, viral pneumonia, and immunodeficiencies.

Main Methods:

• Literature review summarizing evidence on antifungal prophylaxis and pre-emptive treatment.
• Discussion of benefits, harms, and current practices across different clinical settings.

Main Results:

• Strong evidence and recommendations exist for antifungal strategies in hematology, supported by randomized controlled trials.
• Other clinical areas lack high-quality data, leading to center-specific approaches based on local epidemiology and expertise.

Conclusions:

• Future antifungal strategies will be influenced by novel anticancer drugs, intensive care advancements, and new antifungal agents.
• Balancing benefits and harms of antifungal interventions remains critical, especially where high-quality evidence is limited.