Precision dosing of systemic antifungals in adults: therapeutic drug monitoring, empiric dose optimization and barriers to implementation - PubMed
4 days ago
- #therapeutic drug monitoring
- #antifungal therapy
- #precision dosing
- Therapeutic drug monitoring (TDM) is crucial for optimizing systemic antifungal therapy.
- TDM improves efficacy, reduces toxicity, and prevents resistance by enabling individualized dosing.
- Voriconazole, posaconazole, and itraconazole require routine TDM due to interpatient variability and toxicity.
- Fluconazole may need monitoring in critically ill patients or those with CNS infections.
- Isavuconazole has stable pharmacokinetics, limiting TDM to high-risk scenarios.
- Flucytosine requires TDM due to its narrow therapeutic index and resistance risk.
- Echinocandins may need empiric dose adjustments in critically ill or obese patients.
- Liposomal amphotericin B has complex pharmacokinetics, making TDM unreliable.
- Emerging antifungals lack sufficient data to support routine TDM.
- Real-world TDM utilization is inconsistent due to access, logistics, and interpretive challenges.