MSGERC publish recommendations for antifungal stewardship programmes
November 13 2020
While antifungals can save lives, prescribing them inappropriately can lead to resistant strains, or even toxicity and serious drug interactions. Johnson et al (2020) estimate that "As much as 30%–50% of antifungal prescriptions could be optimized or are inappropriate".
Despite the publicity seen in recent years for antibiotics aimed at bacteria, most European hospitals do not have a formal antifungal stewardship programme. A new set of core recommendations has just been published by a group of experts from the Mycoses Study Group Education and Research Consortium (MSGERC), which describes best practice for establishing and running such a programme.
- Antifungal stewardship programmes should be integrated with management and the teams
- Local care pathways ('treatment bundles') should be drawn up
- Centres that often treat invasive fungal infections should have access to on-culture-based diagnostics (galactomannan, BDG)
- An infectious diseases specialist should be consulted for all cases of invasive fungal infection
- Cases involving certain pathogens or high-cost antifungals should be reviewed by an infectious disease specialist, who should give feedback to the prescribing clinician
- Centres that often treat invasive fungal infections should have access to antifungal susceptibility testing
- Therapeutic drug monitoring should be used when prescribing triazoles (itraconazole/voriconazole)
- A clinical pharmacist should review the patient's medications when starting or stopping a new drug, to check for interactions
These recommendations are primarily aimed at the invasive form of aspergillosis but many of the principles also apply to the chronic forms (CPA/ABPA) treated at the National Aspergillosis Centre.
- Read the recommendations (Johnson et al, 2020)
- Learn more from this free online course from FutureLearn in conjunction with BSAC: The Role of Antifungal Stewardship
- Read the Public Health England handbook on antimicrobial resistance