Mitigation of Human-Pathogenic Fungi That Exhibit Resistance to Medical Agents: Can Clinical Antifungal Stewardship Help?

Claire M Hull; Nicola J Purdy; Suzy C Moody


Future Microbiol. 2014;9(3):307-325. 

In This Article

Antifungal Stewardship: Contemporary Drivers & Future Issues

A review of the literature in the field of medical mycology reveals that health economics – specifically the high cost of antifungal drugs – is a clear incentive for promoting better antifungal stewardship.[11] Pilot studies report how antifungal stewardship can facilitate the provision of cost-efficient care through optimal resource utilization and appropriate antifungal drug choice.[12,13] The need for evidence-based dosing guidelines and treatment regimens that minimize toxicity and adverse drug interactions has also been highlighted. Future targets for antifungal stewardship include the development of rapid, accurate diagnostics for a greater range of human-pathogenic fungi, the design of improved (including combination and/or novel) antifungal treatments and the surveillance (local and global trends) of fungal infections.[10] The potential that antifungal stewardship could also have a role in mitigating the emergence of drug-resistant human-pathogenic fungi in the clinical setting (as in the case of bacteria) has recently been raised.[11] However, this concept has not been thoroughly explored, possibly owing to conventional appraisals that have tended to focus on the scale and problem of resistance to one class of medical antifungals, the azoles (Table 1), in comparison with the magnitude and mechanism(s) of multidrug resistance in clinically relevant bacteria.[14–16] Today, emergent research and surveillance information[3,4,17–19] indicates that the factors influencing the scale and epidemiology of human-pathogenic fungi that exhibit resistance to medical antifungals warrant much fuller investigation.