Aspergillosis

Alternativeb Commentsf,g AMB, 3-5 mg/kg/d IV; ABLC, mg/kg/d IV; caspofungin, 70 mg Day 1 , and 50 mg/d IV thereafter; itraconazole osage depends on formulation)c, saconazole 200 mg qid initially, then 0 mg bid PO after stabilization of diseasee milar to invasive pulmonary aspergillosis milar to invasive pulmonary aspergillosis milar to invasive pulmonary aspergillosis Dosage in pediatric patients for voriconazole is 5 to 7 mg/kg IV q12h and for caspofungin 50 mg/m2/d; dosage of posaconazole in pediatric patients has not been defined; indications for surgical intervention are outlined in Table 3 aconazole 200 mg q12h IV for days, followed by 200 mg q24h IV itraconazole 200 mg PO q12h; cafungin 50 mg/d aconazole or voriconazole; similar to vasive pulmonary aspergillosis Efficacy of posaconazole prophylaxis demonstrated in high-risk patients (graft-vs-host disease and acute myelogenous leukemia and myelodysplastic syndrome) Similar to invasive pulmonary aspergillosis Similar to invasive pulmonary aspergillosis As chronic necrotizing pulmonary aspergillosis requires a protracted course of therapy measured in months, an orally administered triazole, such as voriconazole or itraconazole would be preferred over a parenterally administered agent milar to invasive pulmonary aspergillosis This infection is associated with the highest mortality among all of the different patterns of IA; drug interactions with anticonvulsant therapy milar to invasive pulmonary aspergillosis Endocardial lesions caused by Aspergillus spp. require surgical resection; Aspergillus pericarditis usually requires pericardiectomy milar to invasive pulmonary aspergillosis Surgical resection of devitalized bone and cartilage is important for curative intent milar to invasive pulmonary aspergillosis; Systemic therapy may be beneficial in management of Aspergillus mited data with echinocandins endophthalmitis; ophthalmologic intervention and management is recommended for all forms of ocular infection; topical therapy for keratitis is indicated milar to invasive pulmonary aspergillosis Surgical resection is indicated where feasible milar to invasive pulmonary aspergillosis Pre-emptive therapy is a logical extension of empirical antifungal therapy in defining a high-risk population with evidence of invasive fungal infection (eg, pulmonary infiltrate or positive galactomannan) The role of medical therapy in treatment of aspergilloma is uncertain; penetration into pre-existing cavities may be minimal for AMB, but is excellent for itraconazole actical approach is to continue therapy until resolution of all attributable clinical and radiological signs of infection. d by 400 mg/d; although used in some case reports, oral solution is not licensed for treatment of aspergillosis; this is an optimal dose, has not been defined). ance of cases treated with voriconazole in the randomized trial consisted of pulmonary IA, successful treatment of other y for IA. ection until resolution or stabilization of all clinical and radiographic manifestations. Other factors include site of infection antifungal therapy but does require surgery under some circumstances, and the former requires long-term antifungal therapy.

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