Background: The antifungal treatment guidelines for immunosuppressed patients at the Royal Adelaide Hospital were revised (based on a 2004 retrospective drug use evaluation) and implemented in June 2006. Aim: To evaluate clinical practicality and compliance associated with the revised antifungal treatment guidelines for immunosuppressed patients. Method: A prospective drug use evaluation was conducted at the hospital from January to December 2007. Patients admitted to the cancer service who received any of the following antifungals: conventional amphotericin, liposomal amphotericin, voriconazole, caspofungin and posaconazole, were reviewed prospectively according to established criteria. Results: 53 patients who received 112 antifungal courses were evaluated. The majority of antifungals were used for empirical or possible fungal infections. The most common reason for changing antifungals during a treatment course was occurrence of toxicity or adverse effects. Compliance with the guidelines was approximately 70%; the majority of cases of noncompliance were associated with liposomal amphotericin use. Conclusion: The revised guidelines were well accepted and enabled early exclusion of patients who were at high risk of developing nephrotoxicity with conventional amphotericin. ; Kwok-Pui Jody Chu, Minyon Avent, David R Shaw