Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium

doi:10.1002/phar.2850

Review

. 2023 Oct;43(10):1043-1050.

doi: 10.1002/phar.2850. Epub 2023 Aug 14.

Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
² Infectious Disease Connect, Inc., Pittsburgh, Pennsylvania, USA.
³ Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.
⁴ Departments of Medicine and Medical Microbiology & Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁵ Unit of Clinical Pharmacology, Department of Laboratory Medicine, Luigi Sacco University Hospital, Milan, Italy.
⁶ Department of Pharmacy, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
⁷ Department of Molecular Medicine, University of Padua, Padua, Italy.
⁸ Division of Pediatric Clinical Pharmacology and Division of Critical Care, University of Utah, Salt Lake City, Utah, USA.
⁹ Department of Pathology and Laboratory Medicine, Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

PMID: 37459118
DOI: 10.1002/phar.2850

Review

Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium

Erin K McCreary et al. Pharmacotherapy. 2023 Oct.

. 2023 Oct;43(10):1043-1050.

doi: 10.1002/phar.2850. Epub 2023 Aug 14.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
² Infectious Disease Connect, Inc., Pittsburgh, Pennsylvania, USA.
³ Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.
⁴ Departments of Medicine and Medical Microbiology & Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA.
⁵ Unit of Clinical Pharmacology, Department of Laboratory Medicine, Luigi Sacco University Hospital, Milan, Italy.
⁶ Department of Pharmacy, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
⁷ Department of Molecular Medicine, University of Padua, Padua, Italy.
⁸ Division of Pediatric Clinical Pharmacology and Division of Critical Care, University of Utah, Salt Lake City, Utah, USA.
⁹ Department of Pathology and Laboratory Medicine, Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

PMID: 37459118
DOI: 10.1002/phar.2850

Abstract

Triazole antifungals (i.e., fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole) are commonly used in clinical practice to prevent or treat invasive fungal infections. Most triazole antifungals require therapeutic drug monitoring (TDM) due to highly variable pharmacokinetics, known drug interactions, and established relationships between exposure and response. On behalf of the Society of Infectious Diseases Pharmacists (SIDP), this insight describes the pharmacokinetic principles and pharmacodynamic targets of commonly used triazole antifungals and provides the rationale for utility of TDM within each agent.

Keywords: fluconazole; isavuconazole; itraconazole; pharmacodynamics; pharmacokinetics; posaconazole; voriconazole.

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References

REFERENCES

1. Bongomin F, Gago S, Oladele RO, Denning DW. Global and multi-National Prevalence of fungal diseases-estimate precision. J Fungi. 2017;3(4):57. doi:10.3390/jof3040057
1. Rayens E, Norris KA. Prevalence and healthcare burden of fungal infections in the United States, 2018. Open Forum Infect Dis. 2022;9(1):ofab593. doi:10.1093/ofid/ofab593
1. Ostrosky-Zeichner L, Nguyen MH, Bubalo J, et al. Multicenter registry of patients receiving systemic Mold-active triazoles for the Management of Invasive Fungal Infections. Infect Dis Ther. 2022;11(4):1609-1629. doi:10.1007/s40121-022-00661-5
1. Park WB, Kim NH, Kim KH, et al. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. Clin Infect Dis. 2012;55(8):1080-1087. doi:10.1093/cid/cis599
1. Lindsay J, Krantz EM, Morris J, et al. Voriconazole in hematopoietic stem cell transplantation and cellular therapies: real-world usage and therapeutic level attainment at a major transplantation center. Transplant Cell Ther. 2022;28(8):511. doi:10.1016/j.jtct.2022.05.030

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[1] Bongomin F, Gago S, Oladele RO, Denning DW. Global and multi-National Prevalence of fungal diseases-estimate precision. J Fungi. 2017;3(4):57. doi:10.3390/jof3040057

[2] Bongomin F, Gago S, Oladele RO, Denning DW. Global and multi-National Prevalence of fungal diseases-estimate precision. J Fungi. 2017;3(4):57. doi:10.3390/jof3040057

[3] Rayens E, Norris KA. Prevalence and healthcare burden of fungal infections in the United States, 2018. Open Forum Infect Dis. 2022;9(1):ofab593. doi:10.1093/ofid/ofab593

[4] Rayens E, Norris KA. Prevalence and healthcare burden of fungal infections in the United States, 2018. Open Forum Infect Dis. 2022;9(1):ofab593. doi:10.1093/ofid/ofab593

[5] Ostrosky-Zeichner L, Nguyen MH, Bubalo J, et al. Multicenter registry of patients receiving systemic Mold-active triazoles for the Management of Invasive Fungal Infections. Infect Dis Ther. 2022;11(4):1609-1629. doi:10.1007/s40121-022-00661-5

[6] Ostrosky-Zeichner L, Nguyen MH, Bubalo J, et al. Multicenter registry of patients receiving systemic Mold-active triazoles for the Management of Invasive Fungal Infections. Infect Dis Ther. 2022;11(4):1609-1629. doi:10.1007/s40121-022-00661-5

[7] Park WB, Kim NH, Kim KH, et al. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. Clin Infect Dis. 2012;55(8):1080-1087. doi:10.1093/cid/cis599

[8] Park WB, Kim NH, Kim KH, et al. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. Clin Infect Dis. 2012;55(8):1080-1087. doi:10.1093/cid/cis599

[9] Lindsay J, Krantz EM, Morris J, et al. Voriconazole in hematopoietic stem cell transplantation and cellular therapies: real-world usage and therapeutic level attainment at a major transplantation center. Transplant Cell Ther. 2022;28(8):511. doi:10.1016/j.jtct.2022.05.030

[10] Lindsay J, Krantz EM, Morris J, et al. Voriconazole in hematopoietic stem cell transplantation and cellular therapies: real-world usage and therapeutic level attainment at a major transplantation center. Transplant Cell Ther. 2022;28(8):511. doi:10.1016/j.jtct.2022.05.030

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Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium

Affiliations

Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium

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