Brüggemann Roger J M, Aarnoutse Rob E
Department of Pharmacy, Radboud University Medical Center, 864, PO BOX 9101, 6500 HB Nijmegen, The Netherlands ; Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Curr Fungal Infect Rep. 2015;9(2):122-129. doi: 10.1007/s12281-015-0224-3.
Therapeutic drug monitoring (TDM) involves the measurement of plasma or serum drug concentration to adapt dosages to achieve predefined target concentrations that are associated with optimal clinical response while minimizing the chance of encountering toxicity. Many papers in the field of antifungal drugs have focused on the evidence that supports the use of TDM thereby emphasizing the breakpoints or target concentrations in general literature. This review focuses on the process of TDM to inform health care workers on the fundaments and prerequisites that safeguard the good application of TDM. Knowledge on the complete process of TDM including pharmacokinetics (and relevant covariates), pharmacodynamic aspects, trials that are necessary to provide us with evidence, translation of knowledge to other populations and pathogens, and implications for the pre-analytical, analytical, and post-analytical phases (the process of TDM) are discussed in relevant detail. For each individual step, recommendations are made for the readers. We believe this will be a valuable resource and to be of added value to the many papers that focus on relations between exposure and efficacy or toxicity. It will help to achieve greater benefit of TDM.
治疗药物监测（TDM）涉及测定血浆或血清中的药物浓度，以调整剂量，达到预定义的目标浓度，该浓度与最佳临床反应相关，同时将出现毒性的可能性降至最低。抗真菌药物领域的许多论文都聚焦于支持使用TDM的证据，从而在一般文献中强调了断点或目标浓度。本综述聚焦于TDM的过程，以便告知医护人员保障TDM良好应用的基本原理和先决条件。详细讨论了关于TDM完整过程的知识，包括药代动力学（及相关协变量）、药效学方面、为我们提供证据所需的试验、将知识转化到其他人群和病原体的情况，以及对分析前、分析和分析后阶段（TDM过程）的影响。针对每个具体步骤，都为读者提出了建议。我们相信，这将是一份有价值的资源，对于众多关注暴露与疗效或毒性之间关系的论文具有附加价值。它将有助于实现TDM更大的益处。
