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dc.contributor.authorGomez-Lopez, Alicia 
dc.date.accessioned2020-11-11T14:09:49Z
dc.date.available2020-11-11T14:09:49Z
dc.date.issued2020-06-11
dc.identifier.citationClin Microbiol Infect . 2020 Jun 11;S1198-743X(20)30335-9.es_ES
dc.identifier.urihttp://hdl.handle.net/20.500.12105/11320
dc.description.abstractThe goal of therapeutic drug monitoring (TDM) is to determine the appropriate exposure of difficult-to-manage medications to optimize the clinical outcomes in patients in various clinical situations. Concerning antifungal treatment, and knowing that this procedure is expensive and time-consuming, TDM is particularly recommended for certain systemic antifungals: i.e., agents with a well-defined exposure-response relationship and unpredictable pharmacokinetic profile or narrow therapeutic index. Little evidence supports the routine use of TDM for polyenes (amphotericin B), echinocandins, fluconazole or new azoles such as isavuconazole, despite the fact that a better understanding of antifungal exposure may lead to a better response. The aim of this work is to review published pharmacokinetic/pharmacodynamic data on systemically administered antifungals, focusing on those for which monitoring is not routinely recommended by experts. A MEDLINE search of the literature in English was performed introducing the following search terms: amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, triazoles, caspofungin, micafungin, anidulafungin, echinocandins, pharmacokinetics, pharmacodynamics, and therapeutic drug monitoring. Review articles and guidelines were also screened. This review collects different pharmacokinetic/pharmacodynamic aspects of systemic antifungals and summarizes recent threshold values for clinical outcomes and adverse events. Although for polyenes, echinocandins, fluconazole and isavuconazole extensive clinical validation is still required for a clear threshold and a routine monitoring recommendation, particular points such as liposome structure or complex pathophysiological conditions affecting final exposure are discussed. For the rest, their better-defined exposure-response/toxicity relationships allow access to useful threshold values and to justify routine monitoring. Additionally, clinical data are needed to better define thresholds that can minimize the development of antifungal resistance. General TDM for all systemic antifungals is not recommended; however, this approach may help to establish an adequate antifungal exposure for a favourable response, prevention of toxicity or development of resistance in special clinical circumstances.es_ES
dc.description.sponsorshipThis study received support from the Fondo de Investigaciones sanitarias (FIS, reference number PI16CIII/00014, MPY 1347/16); no external funding was received for this work.es_ES
dc.language.isoenges_ES
dc.publisherWileyes_ES
dc.relation.isversionofPostprintes_ES
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectAzoleses_ES
dc.subjectAntifungal exposurees_ES
dc.subjectEchinocandinses_ES
dc.subjectpharmacodynamics targetes_ES
dc.subjectPolyeneses_ES
dc.subjectTherapeutic drug monitoringes_ES
dc.titleAntifungal therapeutic drug monitoring: focus on drugs without a clear recommendation.es_ES
dc.typeArtículoes_ES
dc.rights.licenseAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.identifier.pubmedID32535150es_ES
dc.format.volume26es_ES
dc.format.number11es_ES
dc.format.page1481-1487es_ES
dc.identifier.doi10.1016/j.cmi.2020.05.037es_ES
dc.contributor.funderInstituto de Salud Carlos III 
dc.description.peerreviewedes_ES
dc.identifier.e-issn1469-0691
dc.relation.publisherversionhttps://doi.org/10.1016/j.cmi.2020.05.037es_ES
dc.identifier.journalClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseaseses_ES
dc.repisalud.centroISCIII::Centro Nacional de Microbiologíaes_ES
dc.repisalud.institucionISCIIIes_ES
dc.relation.projectIDinfo:eu-repo/grantAgreement/ES/PI16CIII/00014es_ES
dc.relation.projectIDinfo:eu-repo/grantAgreement/ES/MPY1347/16es_ES
dc.rights.accessRightsinfo:eu-repo/semantics/embargoedAccesses_ES


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Attribution-NonCommercial-NoDerivatives 4.0 Internacional
This item is licensed under a: Attribution-NonCommercial-NoDerivatives 4.0 Internacional