ABSTRACT

This narrative review explores the critical role of antifungal stewardship (AFS) programs in optimizing antifungal use to improve patient outcomes and combat the rising threat of antifungal resistance. The global incidence of invasive fungal infections (IFIs) is increasing, necessitating urgent and effective AFS strategies. We outline the core principles of AFS, including appropriate antifungal selection, tailored treatment, optimized therapy, timely initiation and de-escalation, minimizing adverse effects, reducing healthcare costs, and preventing resistance emergence. Key components essential for the successful implementation of AFS programs are discussed. Current AFS practices are examined, highlighting significant variability in implementation across healthcare settings due to resource availability, local epidemiology, and provider expertise. Additionally, evidence on the effectiveness of AFS programs across multiple institutions worldwide is reviewed. The limitations hindering widespread AFS adoption, including resource constraints, diagnostic challenges, lack of standardization, and inadequate training, are acknowledged. Potential solutions such as enhanced collaboration, comprehensive education and training programs, and a One Health approach to address health disparities are proposed. AFS plays a central role in optimizing antifungal use, improving patient outcomes, and preserving the effectiveness of these essential therapies for future generations.