Pharmacokinetics and optimal exposure of antifungal drugs in critically ill patients

In her thesis Kim van der Elst has evaluated the behavior and the exposure of antifungal drugs and established the relation with the treatment outcome in critically ill adults and children. Furthermore, she has developed noninvasive sampling methods to facilitate monitoring of drug concentrations in blood/body fluids. She has shown that the antifungal drug exposure in critically ill adults and children is often inadequate with the standard dose.

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.

Adequate exposure is essential for an effective treatment, and ultimately, for improved outcome. The findings of Van der Elst 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.

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