Is a dose of itraconazole (ITC) 100 milligrams (mg) twice daily for one week, then stopped for three weeks, and repeated for three cycles, recommended for treating aspergillosis?

From the Guidelines

The dosing regimen of itraconazole 100 mg twice daily for one week, followed by a 3-week break, repeated for 3 cycles, is not the recommended standard treatment for aspergillosis. For invasive aspergillosis, the recommended itraconazole dosing is typically 200 mg twice daily (400 mg/day) given continuously without interruption, usually for a minimum of 6-12 months depending on the clinical response and degree of immunosuppression, as suggested by 1. The pulsed dosing schedule described (one week on, three weeks off) is more commonly used for dermatophyte infections like onychomycosis (fungal nail infections), not for serious invasive fungal infections like aspergillosis. Aspergillosis requires consistent antifungal coverage to effectively treat the infection. Additionally, voriconazole is often preferred as first-line therapy for invasive aspergillosis rather than itraconazole due to better clinical outcomes, as indicated by 1. If itraconazole is used, therapeutic drug monitoring is important to ensure adequate blood levels, as absorption can be variable. The medication should be taken with food or an acidic beverage to enhance absorption. Some key points to consider in the treatment of aspergillosis include:

• The use of voriconazole as primary therapy, with a dosage of 6 mg/kg IV every 12 hours for 1 day, followed by 4 mg/kg IV every 12 hours, as recommended by 1
• The importance of therapeutic drug monitoring for itraconazole, as suggested by 1
• The need for consistent antifungal coverage to effectively treat the infection, as indicated by 1
• The potential for variable absorption of itraconazole, and the importance of taking the medication with food or an acidic beverage to enhance absorption, as suggested by 1.

From the Research

Dose of Itraconazole for Aspergillosis

• The recommended dose of itraconazole for aspergillosis is not explicitly stated as 100 mg twice daily for one week, then stopped for 3 weeks, and repeated for 3 cycles in the provided studies 2, 3, 4, 5, 6.
• However, the studies suggest that itraconazole can be an effective treatment for aspergillosis, with doses ranging from 100 to 400 mg daily 2, 4.
• One study found that itraconazole, 200 to 400 mg once daily, was effective in treating different types of aspergillosis, including pulmonary aspergilloma, chronic necrotizing pulmonary aspergillosis, and invasive aspergillosis 4.
• Another study suggested that itraconazole may be an important advance in the therapy of aspergillosis, with a response rate similar to that of conventional amphotericin B 2.
• The most recent study compared the efficacy of different antifungal drugs, including itraconazole, in the treatment of invasive pulmonary aspergillosis, but did not specifically address the recommended dose 6.

Efficacy of Itraconazole for Aspergillosis

• The studies suggest that itraconazole can be an effective treatment for aspergillosis, with response rates ranging from 50 to 90% 2, 3, 4.
• However, the efficacy of itraconazole may depend on the specific type of aspergillosis, as well as the dose and duration of treatment 4.
• One study found that itraconazole was effective in treating invasive aspergillosis, with a response rate of 75% 4.
• Another study suggested that itraconazole may be an important option for the management of invasive aspergillosis, particularly for consolidation and maintenance therapy 3.