title: [Triazole antifungal agents: practice guidelines of therapeutic drug monitoring and perspectives in treatment optimization].
abstract: Antifungal triazole agents (fluconazole, voriconazole, itraconazole and posaconazole) are widely used for the management of invasive fungal infections (IFI). These drugs are indicated both for the prophylaxis and treatment of IFI, particularly in candidiasis and aspergillosis, major cause of mortality in immunocompromised patients. Due to a large interindividual pharmacokinetic variability leading to sub-therapeutic or toxic concentrations and to concentration-efficacy and/or -toxicity relationships, therapeutic drug monitoring (TDM) of antifungal triazole is fully justified. This review provides an overview of literature based data that confirm the usefulness of such TDM and its level of evidence as well as the practical guidelines for its implementation. In addition, we discuss the interest of new tools to improve the clinical management of IFI, such as genotyping tests optimizing initial voriconazole dosing regimen or the development of a new solid oral tablet of posaconazole improving its bioavailability and limiting absorption disorders.
authors.affiliation: Service de pharmacocinétique et toxicologie, Laboratoire de biologie médicale, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Marseille, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Scodavolpe
authors.affiliation: Service de pharmacocinétique et toxicologie, Laboratoire de biologie médicale, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Marseille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Quaranta
authors.affiliation: Service de pharmacocinétique et toxicologie, Laboratoire de biologie médicale, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lacarelle
authors.affiliation: Service de pharmacocinétique et toxicologie, Laboratoire de biologie médicale, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Marseille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Solas
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016903:Drug Monitoring; D006801:Humans; D009181:Mycoses / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles
keywords: interindividual variability; pharmacokinetic; therapeutic drug monitoring; triazole antifungal