Pharmacokinetics and optimal exposure of antifungal drugs in critically ill patients

Kimberly Corina Maria van der Elst

    Research output: ThesisThesis fully internal (DIV)

    1846 Downloads (Pure)

    Abstract

    With the growing number of immunocompromised and critically ill patients, as the result of aggressive cancer treatment and immunosuppressive treatment after organ transplantation, the incidence of invasive fungal disease has increased in recent years. However, the behavior of a drug in the body and the blood concentration of the drug can be altered in critically ill patients compared to healthy people.
    In this thesis we have evaluated the behavior and the exposure of antifungal drugs and established the relation with the treatment outcome in critically ill adults and children. Furthermore, we have developed noninvasive sampling methods to facilitate monitoring of drug concentrations in blood/body fluids. We have shown that the antifungal drug exposure in critically ill adults and children is often inadequate with the standard dose.
    Adequate exposure is essential for an effective treatment, and ultimately, for improved outcome. Our findings call for the development of a more personalized therapy for patients with invasive fungal disease. This treatment should be based on the characteristics of the fungus and on the characteristics of the patient (underlying disease and treatment of the disease, leading to altered drug behavior). With this strategy, adequate antifungal treatment can be achieved with the current arsenal of antifungal drugs.
    Translated title of the contributionFarmacokinetiek en optimale blootstelling aan antischimmelmiddelen in ernstig zieke patiënten
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    Supervisors/Advisors
    • Kosterink, Jos, Supervisor
    • van der Werf, Tjip, Supervisor
    • Uges, Donald, Supervisor
    • Alffenaar, Jan Willem, Co-supervisor
    • de Bont, Evelina, Assessment committee
    • Mathot, Ron A. A., Assessment committee, External person
    • Verweij, P. E., Assessment committee, External person
    Award date5-Jun-2015
    Place of Publication[Groningen]
    Publisher
    Print ISBNs978-90-367-7864-0
    Electronic ISBNs978-90-367-7863-3
    Publication statusPublished - 2015

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