Invasive aspergillosis (IA)
- Typically occurs in patients with severe immunosuppression; e.g. neutropenic, post-transplantation, post chemotherapy, advanced AIDS, chronic granulomatous disease.
- IA is classified as proven, probable, or possible based on host factors, clinical manifestations and mycological evidence [Clin Infect Dis 2008;46:1813-21.].
- Infectious Diseases consult recommended.
- For central nervous system infection, voriconazole recommended and neurosurgery often required.
- Anidulafungin not listed as limited clinical experience in IA.
Usual Pathogens
Aspergillus fumigatus
Aspergillus flavus
Other Aspergillus spp
Histologically proven or probable IA
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole | 6mg/kg IV q12h first day then either 4mg/kg IV q12h or 200mg PO bid | Until clinical/radiographic resolution |
| or | ||
| Amphotericin B | 1-1.5mg/kg IV daily | Until clinical/radiographic resolution |
Refractory
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Caspofungin | 70mg IV first day then 50mg IV daily | Until clinical/radiographic resolution |
| or | ||
| Micafungin | 100-150mg IV daily | Until clinical/radiographic resolution |