Therapeutic Drug Monitoring of Antifungals: Pharmacokinetic and Pharmacodynamic ConsiderationsSmith, Jeannina MD*; Andes, David MD†Therapeutic Drug Monitoring: April 2008 - Volume 30 - Issue 2 - p 167-172 doi: 10.1097/FTD.0b013e318167d0e0 Proceedings Paper Buy Abstract Author InformationAuthors Article MetricsMetrics Therapeutic drug monitoring of any pharmacologic agent should be considered when there is both significant pharmacokinetic variability and strong, clinically relevant, exposure-effect relationships. Many antifungal drugs exhibit marked variability in drug concentration as a result of inconsistent absorption, metabolism, elimination, or interaction with concomitant medications. For each of the available antifungal drugs, both preclinical and clinical trials have exhibited a relationship between serum concentrations and treatment efficacy. For a smaller subset of compounds, a similar relationship has been identified for the toxicity. The kinetic variability among patients falls outside the therapeutic window for a group of four antifungal compounds. This review summarizes the current literature on therapeutic drug monitoring for these antifungal agents. From the *Department of Medicine, Section of Infectious Diseases, University of Michigan, Ann Arbor, Michigan; and †Department of Medicine, Section of Infectious Diseases and Medical Microbiology and Immunology, University of Wisconsin, Madison, Wisconsin. Received for publication October 24, 2007; accepted December 26, 2007. Correspondence: David Andes, 600 Highland Avenue, Room H4/572, Madison, WI 53792 (e-mail: firstname.lastname@example.org). © 2008 Lippincott Williams & Wilkins, Inc.