Antifungal serum concentration monitoring: an update

Invasive fungal infections (IFIs) are occurring with increasing incidence and are associated with significant morbidity and mortality. Understanding the relationship between the pharmacokinetic and pharmacodynamic properties of antifungals is essential to optimize the potential for favourable clinic...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2008-01, Vol.61 (1), p.17-25
Main Authors: Goodwin, Megan L., Drew, Richard H.
Format: Article
Language:English
Subjects:
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antifungal Agents - adverse effects
Antifungal Agents - blood
Antifungal Agents - pharmacokinetics
Antifungal Agents - therapeutic use
Aspergillus
azoles
Azoles - adverse effects
Azoles - blood
Azoles - pharmacokinetics
Azoles - therapeutic use
Biological and medical sciences
Blood tests
Echinocandins - adverse effects
Echinocandins - blood
Echinocandins - pharmacokinetics
Echinocandins - therapeutic use
Flucytosine - adverse effects
Flucytosine - blood
Flucytosine - pharmacokinetics
Flucytosine - therapeutic use
Fungal infections
Humans
Kinetics
Medical sciences
Microbiology
Monitoring, Physiologic
Mycoses - blood
Mycoses - drug therapy
Patient safety
pharmacodynamics
pharmacokinetics
Pharmacology
Pharmacology. Drug treatments
Risk factors
Toxicity
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Description
Summary:Invasive fungal infections (IFIs) are occurring with increasing incidence and are associated with significant morbidity and mortality. Understanding the relationship between the pharmacokinetic and pharmacodynamic properties of antifungals is essential to optimize the potential for favourable clinical and microbiological outcomes while minimizing risks of treatment-related toxicity. Antifungal serum concentrations may aid in the determination of appropriate dosing in select circumstances. The polyene and echinocandin classes of antifungals lack sufficient data to justify serum concentration monitoring in routine clinical practice. In contrast, serum concentration monitoring of flucytosine may help to reduce the risk of treatment-related haematological toxicity. Determination of itraconazole serum concentrations is advised in situations where the drug is used for prolonged periods to treat serious IFIs (such as invasive aspergillosis or histoplasmosis) because of variability in absorption following oral administration (most notable for the capsule formulation). The use of serum concentration monitoring during therapy with the extended-spectrum triazoles (i.e. voriconazole and posaconazole) is still evolving, due primarily to inter-patient variability in drug exposure combined with sparse data regarding relationships with efficacy (posaconazole) and both safety and efficacy (voriconazole).
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkm389