Challenges in Antifungal Therapy: Therapeutic Drug Monitoring, Drug-Drug Interactions and Approach to Failure After Primary Therapy

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dc.authoridmemişoğlu, funda/0000-0003-3905-1182
dc.authorwosidmemişoğlu, funda/AAA-4392-2021
dc.contributor.authorMemisoglu, Funda
dc.date.accessioned2024-08-04T20:46:54Z
dc.date.available2024-08-04T20:46:54Z
dc.date.issued2019
dc.departmentİnönü Üniversitesien_US
dc.description.abstractAntifungal stewardship programs have been developed to make antifungal use as good as possible. The most important and difficult issues of these program measures are therapeutic drug monitoring (TDM) and drug-drug interactions. TDM of antifungal drugs should be considered when there is an unpredictable drug dose-exposure relationship, a narrow therapeutic range and acceptable safety and efficacy concentration ranges defined. It is recommended for itraconazole, voriconazole, posaconazole and flucytosine in clinical practice. The case for TDM of fluconazole may be beneficial in special circumstances. For isavuconazole, there are insufficient data to support the routine use of TDM. Amphotericin B and echinocandins do not meet the criteria for TDM. Antifungal drugs are involved in many important drug-drug interactions at a high complexity and their management is difficult. Inhibition or induction of cytochrome P450 and P-glycoprotein enzyme systems by azoles is responsible for most drug interactions. There are also interactions that alter the bio-availability of itraconazole and posaconazole. The amphotericin B formulations interact with other drugs primarily by reducing their renal elimination. Echinocandins display a lower potential for drug-drug interactions. The individual approach is the cornerstone in the management of antifungal therapy. Several factors play a role in antifungal therapy response such as the host factors including underlying disease and/or immune status, fungal factors including primary drug resistance or development of resistance under therapy, and drug-related factors (i.e., pharmacokinetics and pharmacodynamics, toxicities, drug-drug interactions, low drug concentration at the site of infection). The patients who do not respond to primary antifungal therapy should be carefully reviewed for these factors.en_US
dc.identifier.doi10.5152/kd.2019.64
dc.identifier.endpage186en_US
dc.identifier.issn1301-143X
dc.identifier.issn1309-1484
dc.identifier.scopus2-s2.0-85074574579en_US
dc.identifier.scopusqualityQ4en_US
dc.identifier.startpage177en_US
dc.identifier.urihttps://doi.org/10.5152/kd.2019.64
dc.identifier.urihttps://hdl.handle.net/11616/99017
dc.identifier.volume32en_US
dc.identifier.wosWOS:000495450600013en_US
dc.identifier.wosqualityN/Aen_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.language.isoenen_US
dc.publisherAvesen_US
dc.relation.ispartofKlimik Journalen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAntifungal agentsen_US
dc.subjectdrug monitoringen_US
dc.subjecttoxicityen_US
dc.subjectdrug interactionsen_US
dc.subjecttreatment failureen_US
dc.titleChallenges in Antifungal Therapy: Therapeutic Drug Monitoring, Drug-Drug Interactions and Approach to Failure After Primary Therapyen_US
dc.typeReview Articleen_US

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