Antifungal therapeutic drug monitoring: focus on drugs without a clear recommendation.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
A Gómez-López

Abstract

The goal of therapeutic drug monitoring (TDM) is to determine the appropriate exposure of difficult-to-manage medications to optimize the clinical outcomes in patients in various clinical situations. Concerning antifungal treatment, and knowing that this procedure is expensive and time-consuming, TDM is particularly recommended for certain systemic antifungals: i.e., agents with a well-defined exposure-response relationship and unpredictable pharmacokinetic profile or narrow therapeutic index. Little evidence supports the routine use of TDM for polyenes (amphotericin B), echinocandins, fluconazole or new azoles such as isavuconazole, despite the fact that a better understanding of antifungal exposure may lead to a better response. The aim of this work is to review published pharmacokinetic/pharmacodynamic data on systemically administered antifungals, focusing on those for which monitoring is not routinely recommended by experts. A MEDLINE search of the literature in English was performed introducing the following search terms: amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, triazoles, caspofungin, micafungin, anidulafungin, echinocandins, pharmacokinetics, pharmacodynamics, and therapeutic drug monitorin...Continue Reading

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Citations

Aug 11, 2020·Current Opinion in Critical Care·Matteo BassettiAntonio Vena
Dec 5, 2020·Evidence-based Complementary and Alternative Medicine : ECAM·Tamirat Bekele BeressaPaul E Alele
May 22, 2021·Infectious Disease Clinics of North America·Melissa D Johnson
May 20, 2021·Current Opinion in Infectious Diseases·Russell E Lewis, David R Andes
Jul 31, 2021·Expert Review of Anti-infective Therapy·Daniel Echeverria-EsnalSantiago Grau
Dec 20, 2021·Therapeutic Drug Monitoring·Benjamin KablyEliane M Billaud

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