Aspergillosis

Selecting a Treatment Regimen Table 2. Recommended Treatments for IA Therapya Condition Invasive pulmonary aspergillosis Invasive sinus aspergillosis Tracheobronchial aspergillosis Chronic necrotizing pulmonary aspergillosis (subacute invasive pulmonary aspergillosis) Primary Voriconazole, 6 mg/kg IV q12h × 2 doses followed L-A by 4 mg/kg IV q12h; oral dosage is 200 mg q12h 5m IV, (do pos 400 Similar to invasive pulmonary aspergillosis Sim Similar to invasive pulmonary aspergillosis Sim Similar to invasive pulmonary aspergillosis Sim Aspergillosis of the central nervous system Similar to invasive pulmonary aspergillosis Sim Aspergillus infections of the heart (endocarditis, pericarditis, myocarditis) d Sim Aspergillus osteomyelitis and septic arthritis d Sim Aspergillus infections of the eye (endophthalmitis d Sim and keratitis) Intraocular AMB indicated with partial vitrectomy lim Cutaneous aspergillosis Aspergillus peritonitis Empirical and pre-emptive antifungal therapy Prophylaxis against IA d d For empirical antifungal therapy, L-AMB, 3 mg/kg/d IV; caspofungin, 70 mg Day 1 IV, and 50 mg/d IV thereafter; voriconazole, 6 mg/kg IV q12h × 2 doses followed by 3 mg/kg IV q12h; oral dosage is 200 mg q12h; itraconazole 200 mg q24h IV or 200 mg bid PO Posaconazole 200 mg q8h PO Aspergillomah No antifungal therapy or surgical resection Sim Sim Itra 2d or i mic Itra inv a Duration of therapy for most conditions of aspergillosis have not been well defined. For treatment of IA in immunocompromised patients, a pra b Alternative (salvage) therapy for patients refractory to or intolerant of primary antifungal therapy. c Dosage of itraconazole for treatment of invasive pulmonary aspergillosis depends on formulation: tablets 600 mg/d for 3 days followed parenteral formulation has been studied in a limited series of 200 mg q12h IV for 2 days followed by 200 mg q24h thereafter (whether d Most of these cases have been treated primarily with deoxycholate amphotericin B in individual case reports. Although the prepondera cases of extrapulmonary and disseminated infection allows one to infer that voriconazole would also be effective in these cases. e Posaconazole has been approved for the salvage treatment of IA in the European Union, but has not been evaluated as primary therapy f Duration of therapy for most conditions for aspergillosis has not been optimally defined. Most experts attempt to treat pulmonary infe (eg, osteomyelitis), level of immunosuppression, and extent of disease. g Reversal of immunosuppression, if feasible, is important for a favorable outcome for IA. h A more recent classification divides aspergilloma into 2 categories—chronic cavitary and single aspergilloma. The latter does not require a

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