Antifungal Guidelines and Stewardship
Invasive antifungal infections have a high mortality rate
despite optimal treatment. Globally fungal associated mortality is comparable
to tuberculosis with an estimated 1.6million deaths annually. Usage of wide
spectrum antifungal agents for unclear indications has led to increasing
resistance in pathogens from more than one of the main antifungal agents.
Unlike bacteria, fungi are eukaryotes with similarities to
their host human cells; therefore they have fewer unique cell targets for
antifungal therapies.
Patient risk factors for candidiasis include:
- Neonate/paediatric, intensive care and frail elderly patients
- Patients on broad-spectrum antimicrobials
- Central intravenous devices
- Gastro-intestinal perforations
- Surgical intervention
- Mould infection
- Immunocompromised patients
Antifungal stewardship encourages responsible empirical
prescribing of antifungals with appropriate follow up of microbiology cultures
to support discontinuation or de-escalation of broad spectrum antifungals.
Good practice points for prescribing antifungals:
- Clear documentation for why antifungal commenced
- Ensure appropriate cultures are ordered and sent
- Prescription review at 48-72 hours documenting
ongoing plan; discontinuing therapy if no longer indicated
- Review efficacy at least weekly; review
available culture results and document ongoing plan including course
length/stop date
- Ensure drug and dose is appropriate – consult
with Trust guidelines below
- Be vigilant for drug interactions e.g.
fluconazole
- Therapeutic drug monitoring where necessary
Please refer to Clatterbridge Cancer Centre guidance for treatment of systemic fungal infections in Haemato-oncology patients: 
Prescribing Guidelines for Treatment of Systemic Fungal Infections in Haemato-Oncology Patients.pdf