17
Treatment
Table 1. Summary of Recommendations for the Treatment
of Aspergillosis (cont'd)
Condition Therapy
Invasive
syndromes of
Aspergillus Primary Alternative Comments
Empirical and
preemptive
antifungal
therapy
For empirical
antifungal therapy:
• Liposomal AmB
(3 mg/kg/day IV)
• Caspofungin
(70 mg day 1 IV
and 50 mg/day
IV thereafter) or
micafungin
(100 mg/day IV)
• Micafungin
(100 mg/day IV)
• 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
3–4 mg/kg q12h)
Preemptive therapy
is a logical extension
of empirical therapy
in a high risk
population with
evidence of invasive
fungal infection
(e.g., pulmonary
infiltrate or positive
GM assay result).
Prophylaxis
against IA
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
• Voriconazole
(200 mg BID)
• Itraconazole
suspension
(200 mg PO every
12 h)
• Micafungin
(50–100 mg/day
IV) or
caspofungin
(50 mg/day IV)
Efficacy of
posaconazole
prophylaxis
demonstrated in
high-risk patients
(patients with
GVHD and
neutropenic patients
with AML or MDS)
Saprophytic
or colonizing
syndromes of
Aspergillus Primary Alternative Comments
Aspergilloma No therapy or
surgical resection
Itraconazole or
voriconazole; similar
to IPA
• The role of
medical therapy
in the treatment
of aspergilloma is
uncertain.
• Penetration into
preexisting cavities
may be minimal
for AmB.
