From the Research
The treatment for Trichosporon asahii infections typically involves systemic antifungal therapy with triazoles, particularly voriconazole, which is considered the first-line treatment. The recommended dosing for voriconazole is a loading dose of 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours, with an oral option of 200-300 mg twice daily for patients who can tolerate oral medication. Treatment duration generally ranges from 2-4 weeks after clinical resolution, though longer courses may be needed for immunocompromised patients. Posaconazole (300 mg daily) or isavuconazole (200 mg daily after loading) can serve as alternatives, as seen in a case where isavuconazole was successfully used to treat T. asahii fungemia in a patient with hematologic malignancies 1. Echinocandins (like caspofungin, micafungin) and amphotericin B are generally less effective against T. asahii due to intrinsic resistance. Combination therapy with a triazole plus an echinocandin or amphotericin B may be considered for severe or refractory cases. Removal of infected catheters or devices is crucial when present, as T. asahii can form biofilms that reduce antifungal efficacy.
Some key points to consider in the treatment of Trichosporon asahii infections include:
- Early diagnosis and appropriate antifungal selection are crucial for treatment success
- Addressing underlying immunosuppression when possible is important for improving outcomes
- The use of voriconazole as the first-line treatment is supported by its efficacy against T. asahii, as shown in a study where voriconazole was found to be the primary drug of choice in the treatment of T. asahii infection 2
- Alternative treatments, such as posaconazole or isavuconazole, may be considered in certain cases, such as when voriconazole is not tolerated or is ineffective
- Combination therapy with a triazole plus an echinocandin or amphotericin B may be considered for severe or refractory cases, as seen in a study where the combination of caspofungin and amphotericin B showed synergistic effects against T. asahii 3
Overall, the treatment of Trichosporon asahii infections requires a comprehensive approach that takes into account the patient's underlying condition, the severity of the infection, and the potential risks and benefits of different treatment options. The most recent and highest quality study supports the use of voriconazole as the first-line treatment 2, and alternative treatments should be considered on a case-by-case basis.