gms | German Medical Science

Frühjahrstagung der Sektion Antimykotische Chemotherapie 2017

Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG e. V.)

17. - 18.03.2017, Bonn

Therapeutic drug monitoring for antifungal triazoles – Recommendations by the 6th European Conference on Infections in Leukemia (ECIL 6)

Meeting Abstract

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  • corresponding author Andreas H. Groll - Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, Münster, Germany

Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG). Frühjahrstagung der Sektion Antimykotische Chemotherapie 2017. Bonn, 17.-18.03.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17sac10

doi: 10.3205/17sac10, urn:nbn:de:0183-17sac105

Veröffentlicht: 13. März 2017

© 2017 Groll.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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 Externer Link