From the Research
Fluconazole is not recommended for the treatment of invasive aspergillosis due to its poor activity against Aspergillus species. The most effective treatment options for invasive aspergillosis include voriconazole, isavuconazole, liposomal amphotericin B, or posaconazole.
Treatment Options
- Voriconazole is typically dosed at 6 mg/kg IV every 12 hours for two doses (loading), followed by 4 mg/kg IV every 12 hours (maintenance) 1.
- Alternatively, oral voriconazole can be used at 200-300 mg twice daily.
- Other effective options include isavuconazole, liposomal amphotericin B, or posaconazole.
Rationale
Fluconazole has poor activity against Aspergillus species due to its mechanism of action, which primarily targets ergosterol synthesis in Candida species but is ineffective against the cell membrane components of Aspergillus 1. This intrinsic resistance makes fluconazole ineffective regardless of dose adjustments.
Clinical Considerations
If a patient presents with invasive aspergillosis, prompt initiation of appropriate antifungal therapy with one of the recommended agents is essential, along with consideration of surgical debridement when feasible and addressing any underlying immunosuppression 2.