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 standard recommended treatment for aspergillosis, even for non-invasive forms with scanty growth. For non-invasive aspergillosis, the typical recommended dose of itraconazole is 200 mg twice daily (400 mg total daily dose) given continuously for at least 6-12 months, depending on the specific type and clinical response, as suggested by the guidelines 1. The pulsed dosing schedule described is more commonly used for dermatophyte infections like onychomycosis (fungal nail infections), not for aspergillosis. Aspergillosis requires more consistent antifungal coverage to effectively eradicate the infection. Some key points to consider when treating aspergillosis with itraconazole include:
- Therapeutic drug monitoring is important to ensure adequate blood levels, as absorption can be variable 1.
- Itraconazole should be taken with food or an acidic beverage to enhance absorption.
- Patients should be monitored for potential drug interactions and side effects such as hepatotoxicity, heart failure, and peripheral neuropathy during treatment. The most recent and highest quality study, published in 2016, provides guidelines for the treatment of aspergillosis, including the recommended dosing regimens for itraconazole 1. It is essential to follow these guidelines to ensure the best possible outcomes for patients with aspergillosis, in terms of morbidity, mortality, and quality of life.
From the Research
Dose of Itraconazole for Aspergillosis
- The recommended dose of itraconazole for aspergillosis is not specified in the provided studies for the exact regimen of 100 mg twice daily for one week, then stopping for 3 weeks, and repeating this dose for 3 cycles.
- However, itraconazole is mentioned as a first-line choice of treatment for chronic pulmonary aspergillosis 2.
- The studies provided focus on the treatment of invasive aspergillosis, and the use of voriconazole, posaconazole, and isavuconazole as alternative treatments 3, 4, 5, 6.
- There is no direct evidence to support the use of the specified itraconazole regimen for scanty growth of aspergillosis.
Treatment of Aspergillosis
- Voriconazole is recommended as the primary treatment for patients with invasive aspergillosis 3, 4, 5, 6.
- Posaconazole and isavuconazole are alternative treatments that can be used in case of resistance or intolerance to voriconazole 2, 4, 6.
- The choice of treatment depends on the severity of the disease, the patient's immune status, and the presence of any underlying conditions.
Antifungal Susceptibility
- The in vitro antifungal susceptibility profile of Aspergillus species isolated from patients with haematological malignancies in Tunisia showed that voriconazole and posaconazole MICs were below the epidemiological cut-off values for all strains 5.
- The study also found that amphotericin B resistant strains were relatively high, making voriconazole a better adapted first-line treatment of invasive aspergillosis in this hospital 5.