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Update on Therapeutic Drug Monitoring of Antifungals for the Prophylaxis and Treatment of Invasive Fungal Infections

  • Current Management of Fungal Infections (M Miceli, Section Editor)
  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Certain antifungals used as therapy for invasive fungal disease, including the extended-spectrum triazoles, may be limited by variable pharmacokinetics and drug interactions. This is especially important when drug exposure, as measured by trough concentrations, may be linked to either efficacy or toxicity. We review the rationale, indications, and controversies in TDM of antifungals.

Recent Findings

The monitoring of voriconazole drug levels is often practiced in patients that receive this triazole based on clinical data. Posaconazole delayed-release tablets achieve higher drug exposure more consistently, necessitating reconsideration of a role for therapeutic drug monitoring. Isavuconazole has predictable population kinetics, although exposure appears to be reduced in certain groups. However, the utility of isavuconazole therapeutic drug monitoring is unknown.

Summary

Therapeutic drug monitoring is warranted for certain antifungals, while its utility is being reconsidered for others.

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Authors and Affiliations

  1. Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    Ilan S. Schwartz

  2. Global Health Institute, University of Antwerp, Antwerp, Belgium

    Ilan S. Schwartz

  3. San Antonio Center for Medical Mycology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Ilan S. Schwartz & Nathan P. Wiederhold

  4. Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Nathan P. Wiederhold

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  1. Ilan S. Schwartz
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Correspondence to Nathan P. Wiederhold.

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Ilan S. Schwartz declares no conflict of interest.

Nathan P. Wiederhold reports grants and served as advisory board member for Astellas; received grants Pfizer, BioMerieux, Viamet, F2G, and Revolution Medicines; and has served as advisory board member and on the speakers bureau for Merck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Current Management of Fungal Infections

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Schwartz, I.S., Wiederhold, N.P. Update on Therapeutic Drug Monitoring of Antifungals for the Prophylaxis and Treatment of Invasive Fungal Infections. Curr Fungal Infect Rep 11, 75–83 (2017). https://doi.org/10.1007/s12281-017-0287-4

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