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​​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 Trust antifungal guidelines for further information on antifungal choice and dosing: Guideline for antifungal prescribing in non-neutropenic adult patients.pdfGuideline for antifungal prescribing in non-neutropenic adult patients.pdf

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.pdfPrescribing Guidelines for Treatment of Systemic Fungal Infections in Haemato-Oncology Patients.pdf