{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T07:52:13Z","timestamp":1720165933093},"reference-count":43,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2009,4,24]],"date-time":"2009-04-24T00:00:00Z","timestamp":1240531200000},"content-version":"vor","delay-in-days":4496,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[1997,1]]},"abstract":"<jats:p><jats:bold>Summary. <\/jats:bold> The prediction of clinical outcome during antifungal therapy is an issue of paramount importance in clinical research, because no consistently reliable parameters are available. Minimum inhibitory concentration (MIC) values and breakpoint interpretation may serve as surrogate criteria until standardized <jats:italic>in vitro<\/jats:italic> antifungal susceptibility testing is developed, especially for fluconazole. With reproducible susceptibility testing methods for <jats:italic>Candida<\/jats:italic> species now available, tentative fluconazole interpretive breakpoints derived from MIC values determined by the National Committee on Clinical Laboratory Standards (NCCLS) M27\u2010T broth macrodilution method are open for public comment. Besides the <jats:italic>in vitro<\/jats:italic> susceptibility of the fungus, clinical response to antifungal therapy with fluconazole depends to a great extent on the daily dose and corresponding plasma and tissue concentrations. Promising results from a few dose\u2010finding studies in non\u2010neutropenic patients show that fluconazole doses of up to 1000 mg day<jats:sup>\u20101<\/jats:sup> result in higher clinical response rates than lower dosages.* Therapeutic success depends substantially on achieving fluconazole plasma and tissue levels that are sufficiently higher than MIC values indicated by <jats:italic>in vitro<\/jats:italic> testing. However, this simplified concept must be related to the clinical situation and it is essential to consider the immunological status and underlying disease of the patient. Misinterpretation of MIC values may result in selection of an antifungal agent for life\u2010threatening infections that does not provide optimal efficacy or toleration.<\/jats:p><jats:p><jats:bold>Zusammenfassung. <\/jats:bold> Die m\u00f6glichst sichere Vorhersage des klinischen Ansprechens unter einer antimykotischen Therapie besitzt h\u00f6chste Priorit\u00e4t, zumal gegenw\u00e4rtig hierf\u00fcr keine verl\u00e4\u00dflichen Parameter verf\u00fcgbar sind. Daher werden MHK\u2010Werte und k\u00fcnftig auch Breakpoints als Surrogatkriterien herangezogen. Allerdings ist die generelle Akzeptanz validierter <jats:italic>in vitro<\/jats:italic>\u2010Testverfahren sowie eine verbesserte Reproduzierbarkeit der Ergebnisse insbesondere f\u00fcr Fluconazol eine wichtige Voraussetzung. Derzeit stehen vorl\u00e4ufige Breakpoints f\u00fcr Fluconazol zur Diskussion, die von dem zust\u00e4ndigen NCCLS\u2010Ausschu\u00df k\u00fcrzlich vorgeschlagen wurden. Diese wurden im Rahmen einer Untersuchung an 519 <jats:italic>Candida<\/jats:italic>\u2010Isolaten von MHK\u2010Werten abgeleitet, die mit einer Makrodilutionsmethode nach NCCLS M27\u2010T Standard bestimmt wurden. Insgesamt h\u00e4ngt das klinische Ansprechen auf eine Therapie mit Fluconazol nicht nur von einer ausreichenden Empfindlichkeit des Erregers, der gew\u00e4hlten Fluconazoldosierung sowie den korrespondierenden Plasma\u2010 und Gewebespiegeln ab, sondern auch in entscheidendem Umfang von der Immunkompetenz und Grunderkrankung des Patienten. Die Ergebnisse einer sehr begrenzten Anzahl von Dosisfindungsstudien mit immunkom\u2010<\/jats:p>","DOI":"10.1111\/j.1439-0507.1997.tb00167.x","type":"journal-article","created":{"date-parts":[[2009,4,24]],"date-time":"2009-04-24T16:45:12Z","timestamp":1240591512000},"page":"25-32","source":"Crossref","is-referenced-by-count":9,"title":["Plasma and tissue concentrations of fluconazole and their correlation to breakpoints"],"prefix":"10.1111","volume":"40","author":[{"given":"L.","family":"Pittrow","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Penk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,4,24]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.32.3.289"},{"key":"e_1_2_1_3_2","first-page":"31","volume-title":"Recent Trends in the Discovery, Development and Evaluation of Antifungal Agents","author":"Boyle F. T.","year":"1987"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/144.4.380"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.1.40"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.Supplement_3.S276"},{"key":"e_1_2_1_7_2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0891-5520(20)30531-6","article-title":"Antifungal susceptibility testing","volume":"7","author":"Pfaller M. A.","year":"1993","journal-title":"Infect. Dis. Clin. North Am."},{"key":"e_1_2_1_8_2","first-page":"325","volume-title":"Significance of Medical Microbiology in the Care of Patients","author":"Sanders W. E.","year":"1982"},{"key":"e_1_2_1_9_2","first-page":"849","volume-title":"Antibiotics in Laboratory Medicine","author":"Stratton C. W. IV.","year":"1991"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01964051"},{"key":"e_1_2_1_11_2","first-page":"387","article-title":"Candida and candidosis","volume":"8","author":"Odds F. C.","year":"1988","journal-title":"Eur. J. Microbiol. Infect. Dis."},{"key":"e_1_2_1_12_2","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1128\/jcm.34.3.489-495.1996","article-title":"Susceptibility testing of fungi: current status of correlation of in vitro data with clinical outcome","volume":"34","author":"Ghannoum M. A.","year":"1996","journal-title":"J. Clin. Microniol."},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.1.40"},{"key":"e_1_2_1_14_2","first-page":"489","article-title":"Identification of patients with acute AIDS\u2010associated cryptococcal meningitis suitable for fluconazole therapy: the role of antifungal susceptibility testing. Clin. Infect. Dis. (in press)","volume":"34","author":"Witt M. D.","year":"1996","journal-title":"J. Clin. Microbiol."},{"key":"e_1_2_1_15_2","volume-title":"In vitro susceptibility of Cryptococcus neoformans predicts failure of primary therapy with fluconazole in patients with cryptococcal meningitis and AIDS. Abstract WS\u2010B12\u20104","author":"Witt M. D.","year":"1993"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.31.9.1343"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.11.2520"},{"key":"e_1_2_1_18_2","volume-title":"National Committee for Clinical Laboratory Standards","author":"National Committee for Clinical Laboratory Standards","year":"1995"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/24.2.235"},{"key":"e_1_2_1_20_2","unstructured":"NCCLS Subcommittee on Antifungal Susceptibility Tests. Summary minutes on the Open meeting held June 1 1996 in Reston VA (unpublished)."},{"key":"e_1_2_1_21_2","doi-asserted-by":"crossref","unstructured":"Bille J. Glauser M.&The Fluconazole Global Susceptibility Study Group(1996)Evaluation of the susceptibility of pathogenicCandidaspecies to fluconazole.Eur. J. Clin. Microbiol. Infect. Dis.(to be published).","DOI":"10.1007\/BF01700561"},{"key":"e_1_2_1_22_2","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1128\/jcm.34.9.2154-2157.1996","article-title":"Fluconazole disc diffusion procedure for determining susceptibility of Candida species","volume":"34","author":"Barry A. L.","year":"1996","journal-title":"J. Clin. Microbiol."},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(94)95926-9"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.Supplement_3.S318"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)81975-4"},{"key":"e_1_2_1_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/172.2.599"},{"key":"e_1_2_1_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.28.5.648"},{"key":"e_1_2_1_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.37.6.1270"},{"key":"e_1_2_1_29_2","volume-title":"Recent Trends in the Discovery, Development and Evaluation of Antifungal Agents","author":"Brammer K. W.","year":"1987"},{"key":"e_1_2_1_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1988.tb40440.x"},{"key":"e_1_2_1_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1988.tb03159.x"},{"key":"e_1_2_1_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.32.3.369"},{"key":"e_1_2_1_33_2","volume-title":"Program and Abstracts of the 28th ICAAC","author":"Rinaldi M. G.","year":"1988"},{"key":"e_1_2_1_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0507.1994.tb00788.x"},{"key":"e_1_2_1_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.33.6.963"},{"issue":"3","key":"e_1_2_1_36_2","first-page":"S318","article-title":"Penetration of fluconazole into vaginal tissues and secretions","volume":"12","author":"Dellenbach P.","year":"1990","journal-title":"Rev. Infect. Dis."},{"key":"e_1_2_1_37_2","volume-title":"Program and Abstracts of the 28th Interscience Conference on Antimicrobial Agents and Chemotherapy","author":"Rinaldi M. G.","year":"1988"},{"key":"e_1_2_1_38_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199324010-00002"},{"key":"e_1_2_1_39_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.36.3.690"},{"key":"e_1_2_1_40_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199039060-00006"},{"key":"e_1_2_1_41_2","volume-title":"Program and Abstracts of the 32nd ICAAC","author":"Anaissie E. J.","year":"1992"},{"key":"e_1_2_1_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/0163-4453(93)92761-K"},{"key":"e_1_2_1_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199606203342516"},{"key":"e_1_2_1_44_2","unstructured":"PfizerInc. Data on file."}],"container-title":["Mycoses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1439-0507.1997.tb00167.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1439-0507.1997.tb00167.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T03:57:31Z","timestamp":1693454251000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1439-0507.1997.tb00167.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,1]]},"references-count":43,"journal-issue":{"issue":"1-2","published-print":{"date-parts":[[1997,1]]}},"alternative-id":["10.1111\/j.1439-0507.1997.tb00167.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1439-0507.1997.tb00167.x","archive":["Portico"],"relation":{},"ISSN":["0933-7407","1439-0507"],"issn-type":[{"value":"0933-7407","type":"print"},{"value":"1439-0507","type":"electronic"}],"subject":[],"published":{"date-parts":[[1997,1]]}}}