Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy, 2014
Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy, 2014
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DOI：
10.1111/imj.12600
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发表时间：
2014-12-01
影响因子：
2.1
通讯作者：
Worth, L. J.
中科院分区：
文献类型：
--
作者：
Chau, M. M.;Kong, D. C. M.;Worth, L. J.
抗真菌药物可能与显著毒性或药物相互作用相关，导致血液系统恶性肿瘤患者的抗真菌药物浓度低于治疗水平，临床结局较差。这些风险可通过临床评估、实验室监测、避免特定药物组合和剂量调整来最小化。可能还需要采取具体措施，例如与进餐有关的口服药物给药的最佳时间、使用预水合和补充电解质。抗真菌药物的治疗药物监测（TDM）是必要的，特别是在不遵守，非线性药代动力学，吸收不足，治疗窗口狭窄，可疑的药物相互作用或意外的毒性遇到。提供了伏立康唑和泊沙康唑TDM在血液病患者临床管理中的推荐适应症。随着药物基因组学对唑类药物（特别是伏立康唑）代谢影响的新知识，提出了药物基因组学评价在临床实践中的潜在应用。
Antifungal agents may be associated with significant toxicity or drug interactions leading to sub-therapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy. These risks may be minimised by clinical assessment, laboratory monitoring, avoidance of particular drug combinations and dose modification. Specific measures, such as the optimal timing of oral drug administration in relation to meals, use of pre-hydration and electrolyte supplementation may also be required. Therapeutic drug monitoring (TDM) of antifungal agents is warranted, especially where non-compliance, non-linear pharmacokinetics, inadequate absorption, a narrow therapeutic window, suspected drug interaction or unexpected toxicity are encountered. Recommended indications for voriconazole and posaconazole TDM in the clinical management of haematology patients are provided. With emerging knowledge regarding the impact of pharmacogenomics upon metabolism of azole agents (particularly voriconazole), potential applications of pharmacogenomic evaluation to clinical practice are proposed.