Volume 43, Issue 10 p. 1043-1050
REVIEW OF THERAPEUTICS

Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists

Endorsed by the Mycoses Study Group Education and Research Consortium

Erin K. McCreary

Erin K. McCreary

Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

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Matthew R. Davis

Matthew R. Davis

Infectious Disease Connect, Inc., Pittsburgh, Pennsylvania, USA

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Navaneeth Narayanan

Navaneeth Narayanan

Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA

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David R. Andes

David R. Andes

Departments of Medicine and Medical Microbiology & Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA

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Dario Cattaneo

Dario Cattaneo

Unit of Clinical Pharmacology, Department of Laboratory Medicine, Luigi Sacco University Hospital, Milan, Italy

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Robbie Christian

Robbie Christian

Department of Pharmacy, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA

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Russell E. Lewis

Russell E. Lewis

Department of Molecular Medicine, University of Padua, Padua, Italy

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Kevin M. Watt

Kevin M. Watt

Division of Pediatric Clinical Pharmacology and Division of Critical Care, University of Utah, Salt Lake City, Utah, USA

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Nathan P. Wiederhold

Nathan P. Wiederhold

Department of Pathology and Laboratory Medicine, Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

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Melissa D. Johnson

Corresponding Author

Melissa D. Johnson

Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA

Correspondence

Melissa D. Johnson, Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Duke Box 102359, Durham, NC 27710, USA.

Email: [email protected]

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First published: 17 July 2023
Citations: 4

Abstract

Triazole antifungals (i.e., fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole) are commonly used in clinical practice to prevent or treat invasive fungal infections. Most triazole antifungals require therapeutic drug monitoring (TDM) due to highly variable pharmacokinetics, known drug interactions, and established relationships between exposure and response. On behalf of the Society of Infectious Diseases Pharmacists (SIDP), this insight describes the pharmacokinetic principles and pharmacodynamic targets of commonly used triazole antifungals and provides the rationale for utility of TDM within each agent.

CONFLICT OF INTEREST STATEMENT

Dr. Andes has received consulting fees from Astellas, Roche, Merck, SFunga, and Amplyx, research grants to his institution from sFUnga, Biosergen, Amplyx, and the National Institutes of Health, and patents for turbinmicin, forazoline, and cyphomycin. Dr. Cattaneo has received consulting fees from Pfizer and Viiv Healthcare, and honoraria from Janssen Cilag and Merck, Sharp & Dohme. Dr. Davis has received consulting fees from Shionogi and Ligand Pharmaceuticals and honoraria from Ligand Pharmaceuticals. Dr. Johnson has received consulting fees from Astellas, Merck, Entasis, Pfizer, and Theratechnologies, author royalties from UpToDate, research grants to her institution from Astellas, Scynexis, Charles River Laboratories, and Merck & Co, and has a patent pending for gene expression-based classifiers of fungal infection, outside the submitted work. She is also on the Board of the Society of Infectious Diseases Pharmacists. Dr. Lewis has received consulting fees from F2G, Gilead, Scynexis, and the British Society for Antimicrobial Chemotherapy, honoraria from Pfizer, Avir, and Gilead, and author royalties from UptoDate. He has also received research grants to his institution from Merck & Co and the European Society for Clinical Microbiology & Infectious Diseases, and materials (antifungal powder) to his institution from Pfizer. Dr. McCreary has received consulting fees from Cidara, Ferring, Summit, LaJolla, Merck, AbbieVie, Shionogi, MeMEd, Entasis, and LabSimply and speaker honoraria from Shionogi. Dr. McCreary has also served on the Board of the Society of Infectious Diseases Pharmacists. Dr. Narayanan has received honoraria from Astellas and Beckman Coulter. Dr. Watt received research grants from NIH and is a member of the American Academy of Pediatrics Committee on Drugs. Dr. Wiederhold has received research grants from Astellas, bioMerieux, F2G, Maxwell Biosciences, Mycovia, and sFunga outside of the submitted work, honoraria from the American Society for Microbiology, Mycoses Study Group Education and Research Consortium, and the Infectious Diseases Society of America and served on an advisory board for F2G. He has received meeting/travel support from Fungal Diagnostics Laboratory Consortium and Clinical Laboratory Standards Institute. He has received materials (antifungal powder) from Cidara, F2G, Mycovia, Pfizer, and Scynexis. All other authors report no report disclosures, conflict of interest, or relevant financial interests related to the content of the manuscript.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.