Therapeutic drug monitoring

Ref ID: 19449

Author:

R. J. M. Bruggemann

Author address:

Radboud University Medical Centre, Nijmegen, the Netherlands

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

The strategy to tailor the individuals’ exposure through the assess-
ment of a patient serum or plasma concentration and subsequently
adaptation of the dosing regimen is called therapeutic drug monitor-
ing (TDM). TDM has since long been used to optimize treatment for
several drug classes, most importantly the aminoglycosides and gly-
copeptides, and has been shown of significant benefit to patients.
Over the past decade a vast amount of evidence has been published
supporting a role for TDM in the class of azole antifungal drugs.
Azole antifungals, such as voriconazole and posaconazole, are rec-
ommended drugs to manage Aspergillus diseases. Voriconazole is
most frequently used in the treatment for IA and posaconazole for
prophylaxis and salvage therapy. To select the most appropriate drug
and to optimize the exposure of the drug by adapting the adminis-
tered dose, understanding of the pharmacokinetics (PK) and pharma-
codynamics (PD) is crucial.
At this time point TDM is increasingly considered a standard of
care for antifungal therapy for at least some drug-pathogen combina-
tions. This workshop will address the underlying concepts and
indications for TDM as a component of antifungal therapy. Subse-
quently, pharmacokinetics and pharmacodynamics (PK/PD) charac-
teristics of voriconazole and posaconazole in different patients
populations will be reviewed and the available evidence on target
concentrations defining maximal efficacy and minimal toxicity will
be discussed. Finally some practical recommendations how to best
perform TDM in clinical practice will be provided.
In short, the following will be addressed: (i) update on the mea-
surement of antifungal agents, including quality control, analytical
methods and turn around time; (ii) potential therapeutic targets for
TDM for various compounds; and (iii) approaches to dosage adjust-
ment to achieve optimal drug exposure for individual patients.

Abstract Number: w05-4

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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