title: Antifungal stewardship considerations for adults and pediatrics.
abstract: Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via post-prescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.
authors: a Division of Infectious Diseases , Children's National Health System , Washington , DC , USA.
authors: Rana F
authors: RF
authors: Hamdy
authors: b Division of Infectious Diseases, Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , PA , USA.
authors: Theoklis E
authors: TE
authors: Zaoutis
authors: c Department of Medicine , Infectious Disease Service, Memorial Sloan Kettering Cancer Center , New York , NY , USA.
authors: Susan K
authors: SK
authors: Seo
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D002175:Candida / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D016903:Drug Monitoring; D025141:Drug Resistance, Fungal; D006801:Humans; D016867:Immunocompromised Host; D000072742:Invasive Fungal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D010372:Pediatrics
chemical_list: D000935:Antifungal Agents
keywords: antifungal resistance; antifungal stewardship; antimicrobial stewardship program; hematologic malignancy; invasive aspergillosis; invasive candidiasis; invasive fungal infection; pediatrics; rapid diagnostics; transplantation