Therapeutic Drug Monitoring of Antifungals: Pharmacokinetic and Pharmacodynamic Considerations
- 1 April 2008
- journal article
- review article
- Published by Wolters Kluwer Health in Therapeutic Drug Monitoring
- Vol. 30 (2) , 167-172
- https://doi.org/10.1097/ftd.0b013e318167d0e0
Abstract
Therapeutic drug monitoring of any pharmacologic agent should be considered when there is both significant pharmacokinetic variability and strong, clinically relevant, exposure-effect relationships. Many antifungal drugs exhibit marked variability in drug concentration as a result of inconsistent absorption, metabolism, elimination, or interaction with concomitant medications. For each of the available antifungal drugs, both preclinical and clinical trials have exhibited a relationship between serum concentrations and treatment efficacy. For a smaller subset of compounds, a similar relationship has been identified for the toxicity. The kinetic variability among patients falls outside the therapeutic window for a group of four antifungal compounds. This review summarizes the current literature on therapeutic drug monitoring for these antifungal agents.Keywords
This publication has 41 references indexed in Scilit:
- Flucytosine therapeutic monitoring: 15 years experience from the UKJournal of Antimicrobial Chemotherapy, 2007
- Derivation of an In Vivo Drug Exposure Breakpoint for Flucytosine againstCandida albicansand Impact of the MIC, Growth Rate, and Resistance Genotype on the Antifungal EffectAntimicrobial Agents and Chemotherapy, 2006
- Attributable Mortality of Nosocomial Candidemia, RevisitedClinical Infectious Diseases, 2003
- Trends in the Epidemiology of Opportunistic Fungal Infections: Predisposing Factors and the Impact of Antimicrobial Use PracticesClinical Infectious Diseases, 2001
- Aspergillosis Case-Fatality Rate: Systematic Review of the LiteratureClinical Infectious Diseases, 2001
- In Vivo Characterization of the Pharmacodynamics of Flucytosine in a Neutropenic Murine Disseminated Candidiasis ModelAntimicrobial Agents and Chemotherapy, 2000
- Itraconazole solution: higher serum drug concentrations and better clinical response rates than the capsule formulation in acquired immunodeficiency syndrome patients with candidosis.Journal of Clinical Pathology, 1997
- Influence of an acidic beverage (Coca-Cola) on the absorption of itraconazoleEuropean Journal of Clinical Pharmacology, 1997
- Pharmacokinetics of itraconazole following oral administration to normal volunteersAntimicrobial Agents and Chemotherapy, 1988
- Toxicity of amphotericin B plus flucytosine in 194 patients with cryptococcal meningitisThe American Journal of Medicine, 1987