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ARTICLE

The Time for Antifungal Stewardship Programs Is Now

NOV 08, 2017 | BETTY VU, PHARMD
Specifically, with antifungal stewardship, there are certain areas for interventions that may differ from antibiotic stewardship to reduce antifungal resistance and selection pressure. For example, appropriate indications for antifungal prophylaxis and treatment should be evidence-based and selected in clinical situations that are efficacious, while avoiding use where fungal or mold colonization may occur.20 Only 55% of physicians were able to correctly differentiate between infection and colonization in a survey of 200 providers, including those from medicine, pediatrics, and surgery, implying that there is a need for education on appropriate antifungal use.27 Both antimicrobial and antifungal stewardships prioritize education as a core element.18,20 Pharmacists have an expertise in pharmacotherapy that is pertinent for effective therapeutic drug monitoring, especially in optimizing antifungals with pharmacokinetic variability.28 However, there are also limitations in availability of laboratory assays and validated efficacy and safety data on drug monitoring.

Overall, there is a great need for establishing antifungal stewardships in institutions with significant antifungal use due to the growing resistance, substantial costs, and potential to optimize outcomes. This is a collaborative effort that requires the teamwork of specialists in dynamic areas among physicians, pharmacists, and microbiologists, at minimum. The success of antifungal stewardship is defined on institution-specific needs and the epidemiology of the hospital. Documented inappropriate use of antifungals warrants opportunities for improvement and education, as part of the core elements of stewardship. Opportunities include interventions requiring infectious diseases consultation for fungemia, candidemia-care bundles, appropriate use of diagnostic biomarkers, therapeutic drug monitoring, and retrospective audit and feedback.  
 
Dr. Vu is a Clinical Assistant Professor at Chicago State University and is in clinical practice at Rush University Children's Hospital in Chicago, Illinois. She completed her PGY-2 residency in infectious diseases at Midwestern University Chicago College of Pharmacy. She is an active member of ACCP, IDSA, and SIDP.

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