ABSTRACT: In general, the management of invasive pulmonary aspergillosis is based on antifungal therapy and reversal of immunosuppression. Voriconazole(Drug information on voriconazole) is the preferred treatment in most cases. Liposomal preparations of amphotericin B(Drug information on amphotericin b), caspofungin(Drug information on caspofungin), and posaconazole are alternatives in patients who cannot tolerate voriconazole or have refractory aspergillosis. Prophylaxis in high-risk patients has gained popularity with the availability of oral extended-spectrum azoles; posaconazole is approved for prophylaxis in patients with acute leukemia, myelodysplastic syndrome, and graft versus host disease. (J Respir Dis. 2008;29(11):429-434)
In the October 2008 issue of The Journal of Respiratory Diseases, we reviewed the clinical presentation and diagnosis of invasive pulmonary aspergillosis. In this article, we will review the treatment options.
Antifungal therapy
Antifungal therapy should be started promptly when aspergillosis is strongly suspected (Table 1). Early treatment may improve survival.1
Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients.2 It blocks the synthesis of ergosterol, which leads to the destruction of the fungal cell membrane, and is considered fungicidal. Voriconazole is available in both oral and intravenous formulations and is well absorbed and widely distributed in body tissues, including the cerebrospinal fluid. For seriously ill patients, voriconazole should be administered intravenously for the first 7 days, followed by oral therapy twice daily. Oral therapy can be used in stable patients.
Voriconazole is also active against many other fungi, including Candida species; Cryptococcus neoformans; Trichosporon species; filamentous fungi; and dimorphic fungi, such as Coccidioides immitis, Histoplasma capsulatum, and Blastomyces dermatitidis. However, it is not active against Zygomycetes.
