Journal
DRUG NEWS & PERSPECTIVES
Volume 23, Issue 2, Pages 93-97Publisher
PROUS SCIENCE, SAU-THOMSON REUTERS
DOI: 10.1358/dnp.2010.23.2.1400855
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Funding
- Pfizer
- Gilead Sciences
- Merck Sharp Dohme
- Schering-Plough
- Astellas
- Merck
- Astellas Pharma
- BioMerieux
- Soria Melguizo SA
- European Union
- ALBAN
- Spanish Agency for International Cooperation
- Spanish Ministry of Culture and Education
- Spanish Health Research Fund
- Institut de Salud Carlos III
- Ramon Areces Foundation
- Mutua Madrilefia Foundation
- AM-Pharma
- Basilea Pharmaceutica
- Merck Sharpe Dohme
- UCB Pharma
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Susceptibility testing of fungi and development of interpretative breakpoints has become increasingly important due to the growing incidence of invasive fungal infections, the number and classes of antifungals, and the emerging reports of acquired resistance. The subcommittee on antifungal susceptibility testing of the European Committee on Antibiotic Susceptibility Testing (EUCAST) has developed standards for susceptibility testing of fermentative yeasts and molds as well as proposing breakpoints for fluconazole and voriconazote against Candida. The aim of this work is to describe the EUCAST process of setting breakpoints for antifungals. Five aspects are evaluated during the process of developing breakpoints: 1) the most common dosage used in each European country, 2) the definition of the wild-type population for each target microorganism at the species level and the determination of epidemiological cutoffs, 3) the drug's pharmacokinetics and 4) pharmacodynamics, including Monte Carlo simulations, and 5) the correlation of MICs with clinical outcome of patients treated with the compound. When insufficient data are available (e.g., due to lack of information on the clinical outcome of infections caused by isolates with an elevated MIC), epidemiological cutoff values, rather than breakpoints, are recommended until the necessary information becomes available.
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