From the Guidelines
Fungal pneumonia treatment typically involves antifungal therapy, with the specific treatment depending on the severity of the disease and the patient's underlying health conditions.
Treatment Options
- For patients with severe disease, treatment with an AmB formulation is recommended, followed by a triazole 1.
- Patients with underlying immunosuppression, substantial cardiopulmonary comorbidities, or those with prolonged infection or high CF titres should be treated with fluconazole or itraconazole 1.
- Patients exhibiting weight loss, night sweats, and infiltrates exceeding 50% of one lung or bilateral disease should be treated with antifungal therapy, particularly if they have high CF titres 1.
- For patients with chronic pulmonary or disseminated disease, antifungal therapy is typically prolonged—potentially lifelong 1.
Antifungal Medications
- Fluconazole and itraconazole are commonly used to treat coccidioidomycosis 1.
- Amphotericin B is often selected for treatment of patients with respiratory failure or rapidly progressive coccidioidal infections 1.
- Voriconazole and posaconazole may be used to treat disease refractory to fluconazole 1.
Treatment Duration
- The duration of therapy often ranges from many months to years, and for some patients, chronic suppressive therapy is needed to prevent relapses 1.
From the Research
Treatment Options for Fungal Pneumonia
The treatment for fungal pneumonia depends on the type of fungus causing the infection. According to 2, voriconazole and liposomal amphotericin B are recommended as primary therapy for invasive pulmonary aspergillosis (IPA), while caspofungin is recommended as salvage therapy.
Antifungal Agents
Various antifungal agents are used to treat fungal pneumonia, including:
- Amphotericin B 3, 4, 5
- Fluconazole 3
- Itraconazole 3
- Ketoconazole 3
- Flucytosine 3
- Voriconazole 4, 5
- Caspofungin 4, 5
- Posaconazole 5
Treatment Approaches
The treatment approach may vary depending on the patient's condition and the type of fungus causing the infection. According to 5, voriconazole is the drug of choice for invasive aspergillosis, while liposomal amphotericin B is the preferred alternative in case of contraindication, drug-related side-effects, or intolerance.
Combination Therapy
The use of combination therapy is still unproven, but it may be considered in certain cases. According to 2, combination therapy may be recommended in critically ill patients with sepsis or severe respiratory failure, although there is no solid data supporting scientific evidence.
Surgical Debridement
Surgical debridement of necrotic tissue may be necessary in some cases to complement antifungal therapy. According to 5, optimal antifungal therapy should be complemented by surgical debridement of necrotic tissue whenever possible.