title: Antifungal stewardship in daily practice and health economic implications.
abstract: During recent years, inappropriate antifungal use has contributed to the global increase in antifungal resistance and has played a role in the shift in the aetiology of invasive fungal infections. Moreover, overuse of antifungals may also lead to higher toxicity associated with unnecessary medication exposure and to increased healthcare costs. Antifungal stewardship (AFS) programmes consist of multidisciplinary interventions, led by specialists in infectious disease, microbiology and pharmacy that cooperate and communicate with the major prescribing departments in order to optimise antifungal therapies evaluating the indication, dose, streamlining and duration. Herein, we review the available evidence for the use of AFS and their impact on health economics. We also describe our AFS program, the successive steps we followed and the main difficulties we found.
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Department of Medicine, Complutense University of Madrid, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Department of Medicine, Complutense University of Madrid, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Department of Medicine, Complutense University of Madrid, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001393:Azoles / Q000627:therapeutic use; D004363:Drug Utilization / Q000592:standards*; D054714:Echinocandins / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy*; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins
keywords: Antifungal stewardship; antifungal therapy; candins; empiric antifungals; fluconazole; invasive candidiasis