What are examples of antifungal therapies for mould (antimould) infections?

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DS

Dainyal Siddiqui, MD

Internal Medicine

MJ

Manuel Jimenez, MD

Cardiology

FP

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 30, 2025 • View editorial policy

From the Guidelines

Fungal anti-mold therapy should primarily involve the use of voriconazole, posaconazole, or liposomal amphotericin B, as these medications have been shown to be effective in treating invasive mold infections, particularly those caused by Aspergillus species, as demonstrated in the 2024 study by the National Comprehensive Cancer Network 1.

Key Considerations

  • The choice of antifungal medication depends on the specific type of mold infection, the patient's immune status, and the severity of the infection.
  • Voriconazole is often considered the primary treatment for invasive aspergillosis, with a loading dose of 6 mg/kg IV every 12 hours for 1 day, followed by 4 mg/kg IV every 12 hours, as recommended in the 2016 guidelines by the Infectious Diseases Society of America 2.
  • Posaconazole is also effective in preventing invasive fungal infections, particularly in patients with neutropenia or those undergoing hematopoietic stem cell transplantation, as shown in the 2024 study by the National Comprehensive Cancer Network 1.
  • Liposomal amphotericin B is an alternative treatment option for invasive mold infections, especially in patients who are intolerant to azole antifungals.

Treatment Duration and Monitoring

  • The duration of treatment depends on the infection site, severity, and patient immune status, but typically ranges from 6-12 weeks for severe invasive mold infections.
  • Monitoring for side effects, such as liver toxicity, is essential during treatment with azole antifungals.
  • Proper identification of the mold species through laboratory testing is crucial for selecting the most effective treatment, as different molds have varying susceptibility patterns to antifungal agents.

Additional Considerations

  • The 2018 guidelines by the American Society of Clinical Oncology and the Infectious Diseases Society of America recommend the use of mold-active antifungals, such as posaconazole or voriconazole, in patients with cancer-related immunosuppression who are at high risk of invasive mold infection 3.
  • The choice of antifungal medication should be individualized based on the patient's specific needs and medical history.

From the FDA Drug Label

Voriconazole has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections Aspergillus fumigatus Aspergillus flavus Aspergillus niger Aspergillus terreus Candida albicans Candida glabrata Candida krusei Candida parapsilosis Candida tropicalis Fusarium spp. including Fusarium solani Scedosporium apiospermum

Examples of fungal anti-mould therapy include:

  • Voriconazole for the treatment of infections caused by Aspergillus species, Fusarium species, and Scedosporium species 4
  • Voriconazole for the treatment of infections caused by Candida species, including Candida albicans, Candida glabrata, and Candida krusei 4
  • Voriconazole for the treatment of Esophageal Candidiasis 4

From the Research

Fungal Anti-Mould Therapy Examples

  • Posaconazole: used as primary treatment for invasive aspergillosis, with studies showing non-inferiority to voriconazole 5
  • Voriconazole: a broad-spectrum triazole antifungal agent, effective against Aspergillus spp., including itraconazole- and amphotericin B-resistant A. fumigatus isolates 6
  • Caspofungin: used in combination with liposomal amphotericin B as an alternative option for primary therapy in invasive aspergillosis 7
  • Isavuconazole: associated with the best probability of favourable response and reduction in mortality against invasive aspergillosis when used as monotherapy 7

Treatment Outcomes

  • Posaconazole has been shown to be effective in treating invasive aspergillosis, with a successful outcome rate of 42% in patients who were refractory to or intolerant of conventional therapy 8
  • Voriconazole has been shown to be effective in treating invasive aspergillosis, with a successful outcome rate of 52.8% in a randomised, nonblind trial 6
  • Combination therapy with liposomal amphotericin B and caspofungin has been shown to be effective in treating invasive aspergillosis, with a favourable response rate of 84.1% and a reduction in mortality of 88.2% 7

Prophylaxis and Treatment

  • Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome, or patients with graft versus host disease after allogeneic transplantation 9
  • Voriconazole and liposomal amphotericin B are recommended for first-line therapy of invasive aspergillosis 9

References

8
Research

Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2007

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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