Artikel
Therapeutic drug monitoring for antifungal triazoles – Recommendations by the 6th European Conference on Infections in Leukemia (ECIL 6)
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Veröffentlicht: | 13. März 2017 |
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Gliederung
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The morbidity and mortality related to invasive fungal infections is substantial and a considerable burden in immunocompromised patients. The evolving understanding of antifungal pharmacology and pharmacokinetic-pharmacodynamic relationships has resulted in therapeutic drug monitoring (TDM) becoming a valuable adjunct to the administration of some azole antifungal agents. TDM may increase the probability of successful outcomes, prevent drug-related toxicity and potentially, the emergence of antifungal drug resistance. Based on a growing body of clinical data, guidelines elaborated by the 6th European Conference on Infections in Leukemia (ECIL 6) strongly recommend TDM for prophylactic and therapeutic use of itraconazole (AII; target: >0.5 (prophylaxis) and >1 mg/L (treatment) to <4 mg/L by HPLC) and voriconazole (AII; target for prophylaxis and treatment: >1–2 mg/L to <5 mg/L); for posaconazole, use of the tablet formulation (or IV formulation) are recommended to maximize probability of achieving target plasma levels (AII) in the setting of prophylaxis and treatment (CIII; >0.7 mg/L for prophylaxis and >1 mg/L for treatment; no upper boundary). For isavuconazole, TDM is indicated for patients receiving tablets or IV formulation in the setting of breakthrough or infection unresponsive to treatment, pathogens with reduced susceptibility, or in the setting of drug interactions (CIII; no target concentrations available). Beyond these evidence based recommendations, the ECIL 6 guidelines provide detailed suggestions on practical issues on azole TDM including timing and dose changes, and open issues that need further investigation.
References
- 1.
- Lewis R, et al. Triazole Antifungal Therapeutic Drug Monitoring. Available from: https://www.ebmt.org/Contents/Resources/Library/ECIL/Documents/2015%20ECIL6/ECIL6-Triazole-TDM-07-12-2015-Lewis-R-et-al.pdf