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Posaconazole: the case for therapeutic drug monitoring

Susan J Howard1, Timothy W Felton, Alicia Gomez-Lopez

  • 1School of Translational Medicine, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom. sue.howard@manchester.ac.uk

Therapeutic Drug Monitoring
|January 5, 2012
PubMed

Insights

Optimizing posaconazole therapy through therapeutic drug monitoring is crucial for improving outcomes in invasive fungal infections. This approach ensures effective drug exposure, especially in critically ill patients, by addressing subtherapeutic concentrations.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive fungal infections (IFIs) present significant morbidity and mortality challenges.
  • Limited antifungal options necessitate optimization of existing treatments.
  • Posaconazole is approved for IFI prevention, oropharyngeal candidiasis, and invasive aspergillosis salvage therapy.

Purpose of the Study:

  • To review the role of therapeutic drug monitoring (TDM) in optimizing posaconazole therapy.
  • To highlight the exposure-response relationship of posaconazole and its clinical implications.

Main Methods:

  • Review of clinical and laboratory animal data on posaconazole exposure and outcomes.
  • Analysis of factors contributing to subtherapeutic posaconazole concentrations, particularly in critically ill patients.
  • Summary of indications and procedures for implementing posaconazole TDM.

Main Results:

  • Posaconazole exhibits clinically relevant exposure-response relationships, with higher drug exposure correlating with better outcomes.
  • Critically ill patients frequently experience subtherapeutic posaconazole concentrations.
  • TDM offers a strategy to personalize posaconazole dosing and improve patient management.

Conclusions:

  • Therapeutic drug monitoring is a valuable tool for optimizing posaconazole use in IFIs.
  • Implementing TDM can help achieve target drug exposures and enhance clinical efficacy.
  • Further integration of TDM into clinical practice is recommended for improved patient care.

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