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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 25, Issue 6, Pages 327-343

Therapeutic drug monitoring for triazoles: A needs assessment review and recommendations from a Canadian perspective

Michel Laverdiere,1 Eric J Bow,2 Coleman Rotstein,3 Julie Autmizguine,4,5 Raewyn Broady,6 Gary Garber,7 Shariq Haider,8 Trana Hussaini,9 Shahid Husain,3 Philippe Ovetchkine,10 Jack T Seki,11,12 and Yves Théorêt5,13

1Department of Microbiology and Infectious Diseases, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
2Departments of Medical Microbiology and Infectious Diseases, and Internal Medicine, Sections of Infectious Diseases and Hematology∕Oncology, Blood and Marrow Transplant, University of Manitoba, Winnipeg, Manitoba, Canada
3Division of Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
4Service des Maladies Infectieuses, Département de Pédiatrie, Canada
5Unité de Pharmacologie Clinique, CHU Ste-Justine, Montreal, Quebec, Canada
6Division of Haematology, University of British Columbia, Vancouver, British Columbia, Canada
7Division of Infectious Diseases, University of Ottawa∕Ottawa Hospital, Canada
8Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
9Solid Organ Transplantation, Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital, Vancouver, British Columbia, Canada
10Service de Maladies Infectieuses, Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, Montreal, Canada
11Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network, Canada
12Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
13Département de Pharmacologie, Université de Montréal, Montreal, Quebec, Canada

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Invasive fungal infections cause significant morbidity and mortality in patients with concomitant underlying immunosuppressive diseases. The recent addition of new triazoles to the antifungal armamentarium has allowed for extended-spectrum activity and flexibility of administration. Over the years, clinical use has raised concerns about the degree of drug exposure following standard approved drug dosing, questioning the need for therapeutic drug monitoring (TDM). Accordingly, the present guidelines focus on TDM of triazole antifungal agents. A review of the rationale for triazole TDM, the targeted patient populations and available laboratory methods, as well as practical recommendations based on current evidence from an extended literature review are provided in the present document.