Insights on antifungal therapeutic drug monitoring from infectious diseases physicians and hospital‐based pharmacists: A focus group analysis

Abstract Background Antifungal therapeutic drug monitoring (TDM) is critical for individualized, precision treatment and prevention of fungal infections, but previous research has highlighted low TDM utilization rates, potentially reflecting long turnaround times, complex testing logistics, results interpretation, and cost. Objectives To inform strategies to increase antifungal TDM use, we assessed TDM‐related knowledge, attitudes, and practices among infectious disease (ID) physicians and pharmacists. Methods We summarized findings from three structured focus group discussions (FGD)—two with six ID physicians each and one with six pharmacists—during March 2024. Open‐ended discussions were held regarding awareness of and experiences with fungal infections and TDM, perceptions of antifungal TDM such as potential benefits, barriers, and challenges to conducting antifungal TDM, and information needs about antifungal TDM. We conducted qualitative transcription‐based analysis to identify themes. Results Six themes emerged from FGDs: (1) variable knowledge and experience with antifungal TDM among participants, (2) the importance of close collaboration between physicians and pharmacists during the TDM process, (3) the main motivators driving TDM use were improving treatment outcomes, preventing toxicity, and addressing pharmacokinetic variability, (4) the perception that antifungal resistance was unrelated to TDM, (5) key barriers were a lack of comprehensive clinical guidelines, long lab testing turnaround times, complex testing logistics, and high costs, and (6) a need for additional clinical data on TDM's impact on outcomes. Conclusions Our findings can inform efforts to increase TDM use by addressing barriers to practice. Development of evidence‐based clinical guidelines and improvements in testing infrastructure across practice settings could increase antifungal TDM use.