15
Treatment
Table 1. Summary of Recommendations for the Treatment
of Aspergillosis
Condition Therapy
Invasive
syndromes of
Aspergillus Primary Alternative Comments
IPA Voriconazole
(6 mg/kg IV every
12 h for 1 day,
followed by 4 mg/kg
IV every 12 h. Oral
therapy can be used
at 200–300 mg
every 12 h or weight
based dosing on a
mg/kg basis).
See full text for
pediatric dosing.
Primary:
• Liposomal AmB
(3–5 mg/kg/day
IV)
• Isavuconazole 200
mg every 8 h for 6
doses, then 200 mg
daily
Salvage:
• ABLC
(5 mg/kg/day IV)
• Caspofungin
(70 mg/day IV × 1,
then 50 mg/day IV
thereafter)
• Micafungin
(100–150 mg/day
IV)
• Posaconazole oral
suspension: 200 mg
TID; Tablet: 300
mg BID on day 1,
then 300 mg daily
IV: 300 mg BID on
day 1, then
300 mg daily
• Itraconazole
suspension (200 mg
PO every 12 h)
Primary:
• Combination
therapy is
not routinely
recommended.
• Addition of
another agent or
switch to another
drug class for
salvage therapy
may be considered
in individual
patients.
• Dosage in pediatric
patients for
voriconazole and
for caspofungin is
different than that
of adults.
• Limited clinical
experience is
reported with
anidulafungin.
• Dosage of
posaconazole in
pediatric patients
has not been
defined.
Invasive sinus
aspergillosis
Similar to IPA Similar to IPA Surgical debridement
as an adjunct to
medical therapy.
Tracheobronchial
aspergillosis
Similar to IPA Adjunctive inhaled
AmB may be useful.
Similar to IPA
Aspergillosis of
the CNS
Similar to IPA Similar to IPA
Surgical resection
may be beneficial in
selected cases.
• This infection is
associated with the
highest mortality
among all of the
different patterns
of IA.
• Drug
interactions with
anticonvulsant
therapy.
