Invasive aspergillosis (IA)
- Typically occurs in patients with severe immunosuppression; e.g. prolonged neutropenia (acute leukemia, MDS), post-allogeneic stem cell or solid organ transplantation, chronic granulomatous disease, high-dose corticosteroids.
- IA is classified as proven, probable, or possible based on host factors, clinical manifestations and mycological evidence.
- Infectious Diseases consult recommended.
- For central nervous system infection, voriconazole or isavuconazole recommended (alternative: liposomal amphotericin B); neurosurgery often required.
- Although anidulafungin has been studied in combination therapy, it has not been evaluated in monotherapy as primary or salvage therapy for IA.
Aspergillus fumigatus
Aspergillus flavus
Other Aspergillus spp
Histologically proven or probable IA
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole | Minimum 6-12 weeks and until clinical/radiographic resolution | |
| or | ||
| Isavuconazole |
200mg PO/IV q8h x 6 doses, then 200mg PO/IV daily |
Minimum 6-12 weeks and until clinical/radiographic resolution |
| or |
|
|
| Posaconazole |
300mg DR tab PO bid on day 1, then 300mg DR tab PO daily |
Minimum 6-12 weeks and until clinical/radiographic resolution |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amphotericin B, liposomal | 3-5mg/kg IV daily | Minimum 6-12 weeks and until clinical/radiographic resolution |
| or | ||
| Amphotericin B, lipid complex | 5mg/kg IV daily | Minimum 6-12 weeks and until clinical/radiographic resolution |
Refractory - progression of disease
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Switch to a different antifungal class: |
||
| Caspofungin | 70mg IV first day then 50mg IV daily | Minimum 6-12 weeks and until clinical/radiographic resolution |
| or | ||
| Micafungin | 100-150mg IV daily | Minimum 6-12 weeks and until clinical/radiographic resolution |
| or | ||
| Posaconazole |
300mg DR tab PO bid on day 1, then 300mg DR tab PO daily |
Minimum 6-12 weeks and until clinical/radiographic resolution |
Refractory - progression of disease - Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amphotericin B, liposomal | 3-5mg/kg IV daily | Minimum 6-12 weeks and until clinical/radiographic resolution |
| or | ||
| Amphotericin B, lipid complex | 5mg/kg IV daily | Minimum 6-12 weeks and until clinical/radiographic resolution |