From the Guidelines
The recommended duration of itraconazole treatment for aspergillosis varies by disease type, but generally lasts at least 6-12 weeks for invasive aspergillosis, 6 months to 1 year for chronic forms, and 4-6 months for allergic bronchopulmonary aspergillosis.
Treatment Overview
The treatment regimen for aspergillosis typically involves voriconazole as first-line therapy, with itraconazole serving as an alternative option 1. For itraconazole treatment, the standard adult dosage is a loading dose of 200 mg three times daily for 3 days, followed by 200 mg twice daily for maintenance.
Key Considerations
- Treatment duration varies by aspergillosis type:
- For invasive aspergillosis, therapy should continue for at least 6-12 weeks and extend several weeks beyond resolution of clinical symptoms and radiographic abnormalities.
- For chronic forms, treatment typically lasts 6 months to 1 year.
- For allergic bronchopulmonary aspergillosis, a 4-6 month course is often sufficient.
- Therapeutic drug monitoring is essential when using itraconazole, with target trough levels of 1-2 μg/mL, as absorption can be variable 1.
- Itraconazole should be taken with food to enhance absorption, and acidic beverages like cola or orange juice can improve bioavailability of the capsule formulation.
- The medication has numerous drug interactions due to CYP3A4 inhibition and can cause side effects including nausea, rash, and elevated liver enzymes, requiring regular monitoring of liver function during treatment.
Dosage and Administration
The dosage of itraconazole for chronic pulmonary aspergillosis is 200 mg twice daily, with adjustments made based on therapeutic drug monitoring 1.
Clinical Guidelines
Clinical guidelines for the diagnosis and management of aspergillosis recommend itraconazole as an alternative option for treatment, with a strength of recommendation of A and quality of evidence of II 1.
From the Research
Treatment Regimen for Aspergillosis
The recommended treatment regimen for aspergillosis, including dosage and duration of itraconazole, is as follows:
- The optimal duration of treatment for chronic pulmonary aspergillosis remains unclear, but a study 2 suggests that treatment with 12 months of oral itraconazole is superior to 6 months of oral itraconazole in reducing relapses at 2 years.
- The dosage of itraconazole used in the study was 400 mg/day, and the mean age of participants was 44·3 (SD 13·3) years.
- Another study 3 used itraconazole, 200 to 400 mg once daily, to treat 49 patients with different types of aspergillosis, including pulmonary aspergilloma, chronic necrotizing pulmonary aspergillosis, and invasive aspergillosis.
Efficacy of Itraconazole
The efficacy of itraconazole in treating aspergillosis is as follows:
- A study 4 found that itraconazole therapy produced responses in 12 of 15 evaluable patients with aspergillosis, including 4 of 5 with invasive pulmonary disease and 2 of 2 with skeletal disease.
- Another study 5 reviewed the role of itraconazole as oral therapy for the major infections caused by Aspergillus spp. and found that itraconazole has been reported to prompt a reduction in corticosteroid dosage in selected patients with allergic bronchopulmonary aspergillosis.
- A study 6 found that itraconazole has become an important option in the management of invasive aspergillosis, with potent and broad spectrum antifungal activity in vitro against Aspergillus spp.
Duration of Treatment
The duration of treatment with itraconazole for aspergillosis is as follows:
- A study 2 suggests that treatment with 12 months of oral itraconazole is superior to 6 months of oral itraconazole in reducing relapses at 2 years.
- Another study 4 used itraconazole for 12 months to treat a patient with joint disease, and found that the patient had a possible relapse three months after completing therapy.
- A study 6 found that itraconazole has an important role for consolidation and maintenance therapy of patients with invasive aspergillosis.