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Review
. 2014 Nov-Dec;25(6):327-43.
doi: 10.1155/2014/340586.

Therapeutic drug monitoring for triazoles: A needs assessment review and recommendations from a Canadian perspective

Michel Laverdiere  1 , Eric J Bow  2 , Coleman Rotstein  3 , Julie Autmizguine  4 , Raewyn Broady  5 , Gary Garber  6 , Shariq Haider  7 , Trana Hussaini  8 , Shahid Husain  3 , Philippe Ovetchkine  9 , Jack T Seki  10 , Yves Théorêt  11
Affiliations
Review

Therapeutic drug monitoring for triazoles: A needs assessment review and recommendations from a Canadian perspective

Michel Laverdiere et al. Can J Infect Dis Med Microbiol. 2014 Nov-Dec.

Abstract
in English, French

Invasive fungal infections cause significant morbidity and mortality in patients with concomitant underlying immunosuppressive diseases. The recent addition of new triazoles to the antifungal armamentarium has allowed for extended-spectrum activity and flexibility of administration. Over the years, clinical use has raised concerns about the degree of drug exposure following standard approved drug dosing, questioning the need for therapeutic drug monitoring (TDM). Accordingly, the present guidelines focus on TDM of triazole antifungal agents. A review of the rationale for triazole TDM, the targeted patient populations and available laboratory methods, as well as practical recommendations based on current evidence from an extended literature review are provided in the present document.

Les infections fongiques invasives sont responsables d’une morbidité et d’une mortalité importantes chez les patients atteints d’une maladie immunodépressive. L’ajout des nouveaux triazoles aux traitements antifongiques a élargi le spectre d’activité et la flexibilité d’administration. Au fil des ans, leur utilisation clinique a suscité des inquiétudes quant au degré d’exposition au médicament selon une posologie approuvée standard, ce qui soulève la nécessité de la pharmacovigilance thérapeutique (PVT). Les présentes lignes directrices portent donc sur la PVT des antifongiques triazolés. Dans le présent document sont exposées une analyse de la raison d’être de la PVT des triazoles, les populations de patients ciblées et les méthodes de laboratoire offertes, de même que des recommandations pratiques fondées sur des données probantes à jour tirées d’une analyse bibliographique approfondie.

Keywords: Invasive fungal infection; Therapeutic drug monitoring; Triazole antifungal antibiotics.

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Figures

Figure 1)
Figure 1)
Number of laboratories, among the 57 that participated in the second round of the International Interlaboratory Quality Control Program for Antifungal Drugs in 2012, that used liquid chromatography techniques coupled to either ultraviolet/diode array/fluorescence (UV-DAD-FL) or mass spectrometry/tandem mass spectrometry (MS/MS-MS) detectors for quantification of azole antifungal. From: International Interlaboratory Quality Control Program for Antifungal Drugs, Second Round 2012. Theoret Y, Personnal Communication
See this image and copyright information in PMC

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