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SHR Neuro Cancer Cardio Lipid Metab Microb

Boyer, J; Hoenigl, M; Kriegl, L.
Therapeutic drug monitoring of antifungal therapies: do we really need it and what are the best practices?
Expert Rev Clin Pharmacol. 2024; 17(4):309-321 Doi: 10.1080/17512433.2024.2317293
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Leading authors Med Uni Graz

Boyer Johannes

Hönigl Martin

Co-authors Med Uni Graz

Kriegl Lisa

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Abstract:

INTRODUCTION: Despite advancements, invasive fungal infections (IFI) still carry high mortality rates, often exceeding 30%. The challenges in diagnosis, coupled with limited effective antifungal options, make managing IFIs complex. Antifungal drugs are essential for IFI management, but their efficacy can be diminished by drug-drug interactions and pharmacokinetic variability. Therapeutic Drug Monitoring (TDM), especially in the context of triazole use, has emerged as a valuable strategy to optimize antifungal therapy. AREAS COVERED: This review provides current evidence regarding the potential benefits of TDM in IFI management. It discusses how TDM can enhance treatment response, safety, and address altered pharmacokinetics in specific patient populations. EXPERT OPINION: TDM plays a crucial role in achieving optimal therapeutic outcomes in IFI management, particularly for certain antifungal agents. Preclinical studies consistently show a link between therapeutic drug levels and antifungal efficacy. However, clinical research in mycology faces challenges due to patient heterogeneity and the diversity of fungal infections. TDM's potential advantages in guiding Echinocandin therapy for critically ill patients warrant further investigation. Additionally, for drugs like Posaconazole, assessing whether serum levels or alternative markers like saliva offer the best measure of efficacy is an intriguing question.

Find related publications in this database (using NLM MeSH Indexing)

Humans - administration & dosage

Antifungal Agents - administration & dosage

Drug Monitoring - administration & dosage

Mycoses - drug therapy

Invasive Fungal Infections - drug therapy, microbiology

Critical Illness - administration & dosage

Find related publications in this database (Keywords)

TDM

Therapeutic drug monitoring

invasive fungal infection

echinocandin

posaconazole

isavuconazole

antifungals

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