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Treatment
Extrapulmonary Aspergillosis
CNS
Î The IDSA recommends voriconazole as primary therapy for CNS
aspergillosis (S-M).
• Lipid formulations of AmB are reserved for those intolerant or refractory to
voriconazole (S-M).
Endophthalmitis
Î The IDSA recommends that Aspergillus endophthalmitis be treated
with systemic oral or intravenous voriconazole plus intravitreal
voriconazole or intravitreal AmB deoxycholate (S-W).
Keratitis
Î The IDSA recommends that clinicians treat Aspergillus keratitis
with topical natamycin 5% ophthalmic suspension or topical
voriconazole (S-M).
Paranasal Sinuses
Î The IDSA recommends that both surgery and either systemic
voriconazole or a lipid formulation of AmB be used in invasive
Aspergillus fungal sinusitis but that surgical removal alone can be
used to treat Aspergillus fungal ball of the paranasal sinus (S-M).
• Enlargement of the sinus ostomy may be needed to improve drainage and prevent
recurrence.
Endocarditis, Pericarditis, and Myocarditis
Î In Aspergillus endocarditis, the IDSA recommends early surgical
intervention combined with antifungal therapy in attempts to prevent
embolic complications and valvular decompensation (S-M).
• Voriconazole or a lipid formulation of AmB is recommended as initial therapy (S-L).
Î Following surgical replacement of an infected valve, lifelong antifungal
therapy should be considered (S-L).
Osteomyelitis and Septic Arthritis
Î Surgical intervention is recommended, where feasible, for
management of Aspergillus osteomyelitis and arthritis, combined
with voriconazole (S-M).
