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Updated: Jun 20, 2025
Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
How can we optimize antifungal use and stewardship in the treatment of acute leukemia?
Thomas Taynton1,2, David Allsup3,4, Gavin Barlow1,5
1Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK.
Introduction:
The global need for antifungal stewardship is driven by spreading antimicrobial and antifungal resistance. Triazoles are the only oral and relatively well-tolerated class of antifungal medications, and usage is associated with acquired resistance and species replacement with intrinsically resistant organisms. On a per-patient basis, hematology patients are the largest inpatient consumers of antifungal drugs, but are also the most vulnerable to invasive fungal disease.
Areas Covered:
In this review we discuss available and forthcoming antifungal drugs, antifungal prophylaxis and empiric antifungal therapy, and how a screening based and diagnostic-driven approach may be used to reduce antifungal consumption. Finally, we discuss components of an antifungal stewardship program, interventions that can be employed, and how impact can be measured. The search methodology consisted of searching PubMed for journal articles using the term antifungal stewardship plus program, intervention, performance measure or outcome before 1 January 2024.
Expert Opinion:
Initial focus should be on implementing effective antifungal stewardship programs by developing and implementing local guidelines and using interventions, such as post-prescription review and feedback, which are known to be effective. Technologies such as microbiome analysis and machine learning may allow the development of truly individualized risk-factor-based approaches to antifungal stewardship in the future.
Insights
Antifungal stewardship is crucial due to rising resistance. Implementing local guidelines and interventions like post-prescription review can reduce antifungal use, especially in vulnerable hematology patients.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Pharmacology
Background:
- Rising antifungal resistance necessitates global antifungal stewardship efforts.
- Triazoles, the primary oral antifungals, are linked to resistance and species replacement.
- Hematology patients are major inpatient antifungal consumers and highly susceptible to invasive fungal diseases.
Purpose of the Study:
- To review current and emerging antifungal drugs and therapies.
- To explore screening-based and diagnostic-driven approaches to reduce antifungal consumption.
- To outline components, interventions, and impact measurement for antifungal stewardship programs.
Main Methods:
- Comprehensive literature search of PubMed using keywords: antifungal stewardship, program, intervention, performance measure, outcome.
- Review focused on articles published before January 1, 2024.
- Synthesis of information on antifungal drugs, prophylaxis, empiric therapy, and stewardship program strategies.
Main Results:
- Effective antifungal stewardship programs require local guidelines and proven interventions like post-prescription review and feedback.
- Available and forthcoming antifungal agents are discussed.
- Screening and diagnostic-driven approaches can optimize antifungal use.
Conclusions:
- Prioritize implementing antifungal stewardship programs with local guidelines and effective interventions.
- Future approaches may leverage microbiome analysis and machine learning for individualized antifungal stewardship.
- Reducing antifungal consumption is key to combating resistance and improving patient outcomes.
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