2
Î The IDSA recommends prophylaxis with posaconazole (S-H),
voriconazole (S-M), and/or micafungin (W-L) during prolonged
neutropenia for those who are at high risk for IA (S-H). Prophylaxis
with caspofungin is also probably effective (W-L). Prophylaxis with
itraconazole is effective, but therapy may be limited by absorption and
tolerability (S-M). Triazoles should not be co-administered with other
agents known to have potentially toxic levels with concurrent triazole
co-administration (such as vinca alkaloids, and others) (S-M).
Graft vs. Host Disease (GVHD)
Î The IDSA recommends prophylaxis with posaconazole for
allogeneic HSCT recipients with GVHD who are at high risk for IA
(S-H). Prophylaxis with other mold-active azoles is also effective.
Voriconazole is commonly used for prophylaxis against IA in high risk
patients but did not show improved survival in clinical trials (S-M).
Prophylaxis with itraconazole is limited by tolerability and absorption
(S-H).
Î The IDSA recommends continuation of antifungal prophylaxis
throughout the duration of immunosuppression in patients with
chronic immunosuppression associated with GVHD (corticosteroid
equivalent of >1 mg/kg/day of prednisone for >2 weeks and/or the use
of other anti-GVHD therapies, such as lymphocyte depleting agents or
tumor necrosis factor-α [TNF-α] inhibition, for refractory GVHD) (S-H).
Lung Transplant
Î The IDSA recommends antifungal prophylaxis with either a
systemic triazole such as voriconazole or itraconazole or an inhaled
amphotericin B (AmB) product for 3–4 months after lung transplant
(S-M).
Î Systemic voriconazole or itraconazole is suggested over inhaled
amphotericin B for lung transplant recipients with mold colonization
pre- or post-lung transplantation, mold infections found in explanted
lungs, fungal infections in the sinus, and single lung transplant
recipients (W-L).
Î The IDSA recommends reinitiating antifungal prophylaxis for lung
transplant recipients receiving immunosuppression augmentation
with either thymoglobulin, alemtuzumab, or high dose corticosteroids
(S-M).
Prophylaxis
