Antifungal Stewardship in Clinical Practice
Summary
Antifungal stewardship encompasses coordinated interventions designed to optimise the use of systemic antifungal agents, improve patient outcomes and minimise the emergence of drug-resistant fungi. Programmes integrate evidence-based guidelines with multidisciplinary collaboration among infectious-disease specialists, pharmacists, microbiologists and front-line clinicians. Core strategies include timely and accurate diagnostics, therapeutic drug monitoring, dose adjustment for organ function and drug–drug interactions, and clear criteria for initiation and de-escalation of therapy. Education and audit with feedback underpin sustainable change, while consumption metrics and process-outcome measures track impact on prescribing patterns, clinical responses and cost-effectiveness. Globally, stewardship efforts address diverse settings—from intensive care units grappling with COVID-19-associated fungal superinfections to immunocompromised populations at risk of invasive disease—highlighting the need for adaptable models that preserve antifungal efficacy and ensure equitable access.
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Antifungal Stewardship in Clinical Practice publication trend
The graph below shows the total number of articles in antifungal stewardship in clinical practice across all publications each year (not limited to Nature Index journals).
Technical terms
Antifungal stewardship: A coordinated programme to optimise antifungal use, balancing patient outcomes with resistance prevention.
Invasive fungal infection (IFI): A severe infection in which fungi invade sterile body sites, such as bloodstream or deep tissues.
Therapeutic drug monitoring (TDM): Measurement of drug concentrations in blood to adjust dosing for efficacy and minimise toxicity.
Empirical therapy: Initiation of antifungal treatment based on clinical suspicion before pathogen identification.
Prophylaxis: Preventive administration of antifungal agents to high-risk patients to avert infection.
Drug–drug interaction: A pharmacological interaction where one drug alters the effect or metabolism of another, requiring dose adjustment.
Consumption metrics: Quantitative measures (e.g. days of therapy per 1,000 patient-days) tracking antimicrobial use over time.
References
- Evaluation of Systemic Antifungal Prescribing Knowledge and Practice in the Critical Care Setting among ICU Physicians and Clinical Pharmacists: A Cross-Sectional Study. Antibiotics (2023).
- Antifungal Stewardship Interventions in Patients with Hematologic Malignancies. Current Fungal Infection Reports (2023).
- Impact of COVID-19 pandemic on antifungal consumption: a multicenter retrospective analysis. Critical Care (2022).
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