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Review
. 2015;9(2):122-129.
doi: 10.1007/s12281-015-0224-3.

Fundament and Prerequisites for the Application of an Antifungal TDM Service

Roger J M Brüggemann  1 , Rob E Aarnoutse  1
Affiliations
Review

Fundament and Prerequisites for the Application of an Antifungal TDM Service

Roger J M Brüggemann et al. Curr Fungal Infect Rep. 2015.

Abstract

Therapeutic drug monitoring (TDM) involves the measurement of plasma or serum drug concentration to adapt dosages to achieve predefined target concentrations that are associated with optimal clinical response while minimizing the chance of encountering toxicity. Many papers in the field of antifungal drugs have focused on the evidence that supports the use of TDM thereby emphasizing the breakpoints or target concentrations in general literature. This review focuses on the process of TDM to inform health care workers on the fundaments and prerequisites that safeguard the good application of TDM. Knowledge on the complete process of TDM including pharmacokinetics (and relevant covariates), pharmacodynamic aspects, trials that are necessary to provide us with evidence, translation of knowledge to other populations and pathogens, and implications for the pre-analytical, analytical, and post-analytical phases (the process of TDM) are discussed in relevant detail. For each individual step, recommendations are made for the readers. We believe this will be a valuable resource and to be of added value to the many papers that focus on relations between exposure and efficacy or toxicity. It will help to achieve greater benefit of TDM.

Keywords: Antifungal agents; Isavuconazole; Pharmacokinetics; Posaconazole; Therapeutic drug monitoring; Triazoles; Voriconazole.

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Figures

Fig. 1
Fig. 1
Requirement for a good application of the TDM service
Fig. 2
Fig. 2
TDM as a process: “the total testing process” with 3 components and 11 steps (adapted and modified from [48]
See this image and copyright information in PMC

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