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Patients with heart transplantation have a high incidence of infectious complications, especially fungal infections. The aim of the systematic review was to determine the best pharmacological strategy to prevent fungal infections among patients with heart transplant. We searched the PubMed and Embase databases for studies reporting the effectivenesss of pharmacologic strategies to prevent fungal infections in adult patient with a heart transplant. Our search yielded five studies (1176 patients), four of them with historical controls. Two studies used inhaled amphotericin B deoxycholate, three used itraconazole and one used targeted echinocandin. All studies showed significant reduction in the prophylaxis arm. Different products, doses and outcomes were noted. There is a highly probable benefit of prophylaxis use, however, better studies with standardised doses and comparators should be performed.