It’s vital that we act now to protect tomorrow – the future of antifungal resistance is in our hands. One way to take action is with an antifungal stewardship programme: a type of specialist intervention aimed at optimising the care of patients with invasive fungal infections.^1,2 

NHS England antifungal spend is over £80 million per annum.³ With an AFS programme, drug costs can be reduced while patient outcomes can be improved: estimates suggest an overall financial opportunity of £4–8 million per annum.^2,3

Aside from the potential value benefit, putting measures in place can help to protect the future. Stewardship programmes can be effective in reducing inappropriate antifungal use and limiting emerging resistance.^1,2 

A successful AFS programme can help to develop guidelines, protocols, and best-practice guidance.⁴ Day to day, an AFS programme can form a part of regular audits, staff surveys, educational initiatives, ward rounds, and multidisciplinary team (MDT) meetings, helping to build on pre-existing management strategies and establish AFS ‘champions’, i.e., individuals with the relevant expertise to influence clinical practice.^4,5

There is not yet a national consensus on AFS strategy aside from following local guidance for managing invasive fungal infections.⁴ However, putting measures in place today can help to protect antifungal use and forge a new path for the future. 

The first step for many in developing their own AFS programme is to establish an MDT that can support decision-making, bringing together expertise for the management of invasive fungal infections.^4,5 Your team might include clinical pharmacists, microbiologists, infectious diseases specialists, and haematologists. Core members should have knowledge of and experience in:^1,4–6

• Clinical management of relevant patient populations
• Fungal epidemiology and susceptibility patterns
• Laboratory diagnosis of invasive fungal infections
• Pharmacokinetics and interactions of antifungal drugs
• Dosing

Management of invasive fungal infections is complex, but having a multidisciplinary team in place could help your Trust to develop and implement AFS practices. Once you have set up your team you can get started with implementing an AFS programme by establishing prescribing guidelines, conducting initial audits and performing a diagnostics gap analysis.

A successful AFS programme requires continued surveillance of fungal infections, optimised diagnostics (including access and screening), and appropriate treatment choices. Doing so can help to reduce resistance, minimise bed stay, prevent unnecessary exposure to antifungals, and improve value.⁴ Different hospitals and regions have employed their own AFS strategies – taking note of successful examples can help to optimise your own AFS programme for your Trust.

ABS, antibacterial stewardship; AFS, antifungal stewardship; AMS, antimicrobial stewardship; MDT, multidisciplinary team;
NHS, National Health Service; TDM, therapeutic drug monitoring.

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