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Review
. 2025 Oct 25;190(6):103.
doi: 10.1007/s11046-025-01011-y.

Antifungal Prescription and Stewardship in Pediatrics

Paschalis Evangelidis  1 , Elisavet Chorafa  1 , Maria Kourti  1 , Elias Pilianidis  1 , Elias Iosifidis  2
Affiliations
Review

Antifungal Prescription and Stewardship in Pediatrics

Paschalis Evangelidis et al. Mycopathologia. .

Abstract

Invasive fungal infections constitute a major cause of morbidity and mortality in children, affecting mainly those with malignancies and immunodeficiencies (primary or secondary), who receive solid or hematopoietic stem cell transplantation, and those in neonatal or pediatric intensive care units. Overuse and inappropriate prescription of antifungal (AF) agents have been reported in pediatrics, leading not only to an increase in adverse events and toxicities but also to the development of AF resistance. AF stewardship practices as part of broader antimicrobial stewardship programs are crucial for improving outcomes and reducing AF overuse and associated costs. This review has two main objectives: to summarize the published data on prescription patterns of AF agents in pediatrics and to describe the current state of pediatric AF stewardship programs worldwide, providing suggestions for their implementation. Given the significant burden of invasive fungal infections in vulnerable pediatric populations, identification of actions to improve AF stewardship practices in real-life clinical settings is essential.

Keywords: Antifungal; Invasive fungal disease; Neonatal; Pediatrics; Prescription; Stewardship.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have not disclosed any competing interests for this manuscript.

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