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Therapeutic Drug Monitoring of Antifungals: Pharmacokinetic and Pharmacodynamic Considerations

Smith, Jeannina MD*; Andes, David MD

doi: 10.1097/FTD.0b013e318167d0e0
Proceedings Paper

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: dra@medicine.wisc.edu).

© 2008 Lippincott Williams & Wilkins, Inc.