What is the treatment for Aspergillosis (Aspergillus infection)?

From the Guidelines

The treatment of Aspergillus infections typically involves antifungal medications, with voriconazole being the first-line therapy for invasive aspergillosis, as recommended by the most recent guidelines 1.

Treatment Overview

The recommended dosing for voriconazole is 6 mg/kg IV every 12 hours for two doses (loading), followed by 4 mg/kg IV every 12 hours, or 200-300 mg orally twice daily.

• Treatment duration generally ranges from 6-12 weeks but may be longer depending on the extent of infection and immune status.
• Alternative medications include isavuconazole (200 mg IV/oral three times daily for 2 days, then 200 mg daily), liposomal amphotericin B (3-5 mg/kg/day IV), or posaconazole (300 mg twice daily on first day, then 300 mg daily) 1.

Specific Conditions

• For allergic bronchopulmonary aspergillosis, treatment involves corticosteroids and possibly itraconazole.
• Aspergillomas may require surgical resection if symptomatic.

Monitoring and Success Factors

• Therapeutic drug monitoring is essential for azoles to ensure adequate blood levels while avoiding toxicity.
• Treatment success depends on controlling underlying conditions that compromise immunity, such as neutropenia or immunosuppressive medications.
• Aspergillus infections can be life-threatening, particularly in immunocompromised patients, making prompt and appropriate treatment crucial for improving outcomes, as highlighted in recent guidelines 1 and studies 1.

From the FDA Drug Label

Voriconazole, administered orally or parenterally, has been evaluated as primary or salvage therapy in 520 patients aged 12 years and older with infections caused by Aspergillus spp., Fusarium spp., and Scedosporium spp.

Study 307/602 – Primary Therapy of Invasive Aspergillosis The efficacy of voriconazole compared to amphotericin B in the primary treatment of acute IA was demonstrated in 277 patients treated for 12 weeks in a randomized, controlled study (Study 307/602).

Voriconazole was administered intravenously with a loading dose of 6 mg/kg every 12 hours for the first 24 hours followed by a maintenance dose of 4 mg/kg every 12 hours for a minimum of 7 days. Therapy could then be switched to the oral formulation at a dose of 200 mg every 12 hours.

The treatment for Aspergillosis (Aspergillus infection) is Voriconazole. The recommended dosage is:

• Intravenous: 6 mg/kg every 12 hours for the first 24 hours, followed by 4 mg/kg every 12 hours for a minimum of 7 days.
• Oral: 200 mg every 12 hours. This treatment has been shown to be effective in a randomized, controlled study 2.

From the Research

Treatment Options for Aspergillosis

The treatment for Aspergillosis, also known as Aspergillus infection, typically involves the use of antifungal medications. The choice of treatment depends on the severity and type of infection, as well as the patient's overall health.

Antifungal Medications

• Voriconazole is a commonly recommended treatment for invasive pulmonary aspergillosis (IPA) 3, 4, 5, 6.
• Isavuconazole and posaconazole are also effective treatments for IPA, with similar efficacy to voriconazole 3, 4, 5.
• Amphotericin B (AmB) formulations, including liposomal AmB, are also used to treat IPA, although they may have more side effects than voriconazole 3, 4, 6, 7.
• Caspofungin and micafungin are echinocandins that have been shown to be effective in treating invasive aspergillosis, particularly in patients who are intolerant to other treatments 4, 5.
• Combination therapy with voriconazole and anidulafungin may be an alternative option for patients with limited drug tolerance 3.

Treatment Guidelines

• The North American Infectious Disease Society's (IDSA) Guidelines recommend voriconazole as the primary treatment for invasive aspergillosis, with amphotericin B-desoxycholate reserved for regions with restricted resources 4.
• Posaconazole is recommended for prophylaxis against aspergillosis in patients with acute myelogenous leukemia, myelodysplastic syndrome, or graft-versus-host disease after allogeneic transplantation 5.

Important Considerations

• Early diagnosis and treatment are crucial in reducing mortality from invasive aspergillosis 5, 7.
• Restoration of host immune defenses is an important aspect of treatment, particularly in immunocompromised patients 7.
• Patients at high risk of developing aspergillosis should be treated promptly, even if microbiological or histological diagnosis is not available 7.