Guidelines for the use of antifungal agents in patients with invasive fungal infections in Taiwan--revised 2009.

Invasive fungal infections are associated with significant morbidity and mortality despite advances in medical care. Aggressive diagnostic approaches in “at risk” patients, coupled with prompt antifungal therapy, are essential for patient survival. Early intervention is strongly recommended, rather than waiting for microbiological or histopathological confirmation. The selection of antifungal agents depends on the severity of the illness, the most likely infecting pathogen and its antifungal susceptibility, any prior exposure to antifungal agents, drug toxicity, and the presence of organ dysfunction, as well as all available knowledge regarding the use of a particular drug in the given patient population. Antifungal agents should be used rationally. De-escalation of empirical therapy based on clinical response and laboratory results is important to avoid the selection of antifungal resistance and the unnecessary use of medical resources. Over the last 3 years, more antifungal agents have become available and new evidence has accumulated, and so these guidelines have been updated accordingly. The aim of this document is to provide national guidance on improving the use of antifungal agents. Three principles provided the framework for these guidelines: 1. The Guidelines should be based on academic principles, rather than the regulations of the Bureau of National Health Insurance on antibiotic usage. The majority of recommendations should be evidence-based, encompassing randomized controlled clinical trials and other study results, case reports and expert opinion. Also, the Guidelines should follow the main structure of similar documents produced by the Infec tious Diseases Society of America. 2. The Guidelines should be based on the local epidemiology and susceptibility patterns of pathogens. The heterogeneity Guideline