Antifungal stewardship: What we need to know

Ray, Arunima; Das, Anupam; Panda, Saumya

doi:10.25259/ijdvl_91_2022

Cited by 16 publications

(13 citation statements)

References 47 publications

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“…Finally, greater awareness should be fostered among both physicians and the public to understand the threat of antifungal resistance. 105 Patients require improved plain-language education on the importance of seeking professional diagnosis and effective treatment options, as well as the consequences of irresponsible antifungal usage. Education of physicians may be the most important first step in any antifungal stewardship programme and should begin early in medical training to foster greater appreciation for the threat of antifungal resistance; the significant role of confirmatory and susceptibility testing; and appropriate antifungal choice, dosing, monitoring, treatment duration and follow-up.…”

Section: Anɵbiograms and Regional Epidemiology Monitoringmentioning

confidence: 99%

“…Education of physicians may be the most important first step in any antifungal stewardship programme and should begin early in medical training to foster greater appreciation for the threat of antifungal resistance; the significant role of confirmatory and susceptibility testing; and appropriate antifungal choice, dosing, monitoring, treatment duration and follow-up. 67,105,106…”

Section: Anɵbiograms and Regional Epidemiology Monitoringmentioning

confidence: 99%

“…Finally, greater awareness should be fostered among both physicians and the public to understand the threat of antifungal resistance 105 . Patients require improved plain‐language education on the importance of seeking professional diagnosis and effective treatment options, as well as the consequences of irresponsible antifungal usage.…”

Section: Counteracting Resistance Through Antifungal Stewardshipmentioning

confidence: 99%

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Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Gupta,

Elewski,

Joseph

et al. 2024

Mycoses

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A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole—the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes—has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug–drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real‐world long‐term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.

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Section: Anɵbiograms and Regional Epidemiology Monitoringmentioning

confidence: 99%

Section: Anɵbiograms and Regional Epidemiology Monitoringmentioning

confidence: 99%

Section: Counteracting Resistance Through Antifungal Stewardshipmentioning

confidence: 99%

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Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Gupta,

Elewski,

Joseph

et al. 2024

Mycoses

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“… 60 , 62 , 63 This is essential with sustainable antifungal stewardship programmes (AFSPs) needing to be developed and promoted globally to reduce AFR. 17 , 23 , 64–69 …”

Section: Introductionmentioning

confidence: 99%

Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications

Mudenda,

Matafwali,

Mukosha

et al. 2023

JAC-Antimicrobial Resistance

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Introduction Antifungal resistance (AFR) is a growing global public health concern. Little is currently known about knowledge, attitudes and practices regarding AFR and antifungal stewardship (AFS) in Zambia, and across the globe. To address this evidence gap, we conducted a study through a questionnaire design starting with pharmacy students as they include the next generation of healthcare professionals. Methods A cross-sectional study among 412 pharmacy students from June 2023 to July 2023 using a structured questionnaire. Multivariable analysis was used to determine key factors of influence. Results Of the 412 participants, 55.8% were female, with 81.6% aged between 18 and 25 years. Most students had good knowledge (85.9%) and positive attitudes (86.7%) but sub-optimal practices (65.8%) towards AFR and AFS. Overall, 30.2% of students accessed antifungals without a prescription. Male students were less likely to report a good knowledge of AFR (adjusted OR, AOR = 0.55, 95% CI: 0.31–0.98). Similarly, students residing in urban areas were less likely to report a positive attitude (AOR = 0.35, 95% CI: 0.13–0.91). Fourth-year students were also less likely to report good practices compared with second-year students (AOR = 0.48, 95% CI: 0.27–0.85). Conclusions Good knowledge and positive attitudes must translate into good practices toward AFR and AFS going forward. Consequently, there is a need to provide educational interventions where students have low scores regarding AFR and AFS. In addition, there is a need to implement strategies to reduce inappropriate dispensing of antifungals, especially without a prescription, to reduce AFR in Zambia.

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“…The fourth article tries to highlight this issue and focuses on why anti-fungal stewardship is the need of the hour. [ 3 ]…”

mentioning

confidence: 99%

Dermatophytosis

Das

2023

Indian Journal of Dermatology

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Antifungal stewardship: What we need to know

Cited by 16 publications

References 47 publications

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications

Dermatophytosis

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