Journal of Antimicrobial Chemotherapy, Vol 40, 753-764, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
KK Summers, TC Hardin, SJ Gore and JR Graybill
The use of systemic antifungal therapy has significantly increased in
recent years. Individualization of antifungal therapy through the use of
serum or plasma concentrations has been suggested, although no specific
recommendations have been developed. The important criteria for therapeutic
drug monitoring and which of these criteria are satisfied by systemic
antifungal agents are presented in this review. No one antifungal is
ideally suited for application of therapeutic drug monitoring, but, under
certain circumstances, obtaining serum or plasma concentrations can be
justified. In patients who are susceptible to flucytosine toxicity, serum
flucytosine concentrations should be monitored in an effort to avoid
untoward side-effects. In contrast, therapeutic drug monitoring of
amphotericin B is not recommended in the clinical setting. Demonstrating
that ketoconazole and itraconazole are reaching the systemic circulation by
obtaining serum concentrations may be clinically useful due to the large
variability in their absorption and issues of patient compliance which may
be seen with these agents. The bioavailability of fluconazole is much less
varied although validation of compliance is a situation where obtaining
serum concentrations may provide additional information.
REVIEWS
Therapeutic drug monitoring of systemic antifungal therapy
Department of Pharmacology, The University of Texas Health Science Center, San Antonio 78284-6220, USA.
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