Materiały źródłowe

• #1 Treatment and prevention of invasive aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-and-prevention-of-invasive-aspergillosis

  Treatment and prevention of invasive aspergillosis […] The effective management of invasive aspergillosis includes strategies to optimize prevention, prompt diagnosis, early antifungal treatment, and, in some cases, immunomodulation and surgery. […] The treatment and prevention of invasive aspergillosis are reviewed here. […] Optimal management involves early and definitive diagnosis as well as early initiation of antifungal therapy. In addition to antifungal therapy, surgery should be considered for patients with certain manifestations. Reduction of immunosuppression, when feasible, is another important component of management.

• #1 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend primary treatment with voriconazole (strong recommendation; high-quality evidence). […] Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence). […] Alternative therapies include liposomal AmB (strong recommendation; moderate-quality evidence), isavuconazole (strong recommendation; moderate-quality evidence), or other lipid formulations of AmB (weak recommendation; low-quality evidence). […] Combination antifungal therapy with voriconazole and an echinocandin may be considered in select patients with documented IPA (weak recommendation; moderate-quality evidence). […] Primary therapy with an echinocandin is not recommended (strong recommendation; moderate-quality evidence). Echinocandins (micafungin or caspofungin) can be used in settings in which azole and polyene antifungals are contraindicated (weak recommendation; moderate-quality evidence).

• #1 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. […] Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. […] Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice. […] Early systemic antifungal treatment is of primary importance for survival against IA, while surgery plays an important role mainly in rarer disease manifestations of invasive disease including, e.g., sinusitis and osteomyelitis.

• #1 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend that treatment of IPA be continued for a minimum of 612 weeks, largely dependent on the degree and duration of immunosuppression, site of disease, and evidence of disease improvement (strong recommendation; low-quality evidence). […] For patients with successfully treated IPA who require subsequent immunosuppression, secondary prophylaxis should be initiated to prevent recurrence (strong recommendation; moderate-quality evidence). […] Reducing doses of, or eliminating altogether, immunosuppressive agents, when feasible, is advised as a component of anti-Aspergillus therapy (strong recommendation; low-quality evidence). […] Colony-stimulating factors may be considered in neutropenic patients with diagnosed or suspected IA (weak recommendation; low-quality evidence). […] Granulocyte transfusions can be considered for neutropenic patients with IA that is refractory or unlikely to respond to standard therapy, and for an anticipated duration of more than one week (weak recommendation; low-quality evidence).

• #1 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  Aspergillosis treatments vary with the type of disease. Possible treatments include: […] Simple, single aspergillomas often don’t need treatment, and medications aren’t usually effective in treating these fungal masses. Instead, aspergillomas that don’t cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medications may be recommended. […] The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from worsening. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren’t helpful for allergic bronchopulmonary aspergillosis, but they may be combined with corticosteroids to reduce the dose of steroids and improve lung function. […] These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option.

• #1 Treatment of allergic bronchopulmonary aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-allergic-bronchopulmonary-aspergillosis

  Treatment of allergic bronchopulmonary aspergillosis (ABPA) aims to control episodes of acute inflammation and to limit progressive lung injury. The roles of systemic glucocorticoids and antifungal agents vary with the disease activity. Antifungal therapy may help to decrease exacerbations. Inhaled glucocorticoids may help control symptoms of asthma but do not have documented efficacy in preventing acute episodes of ABPA. […] For acute ABPA manifest by radiographic opacities (usually upper or middle lobes) and an elevated total serum IgE (generally >1000 international units/mL), systemic glucocorticoids are the mainstay of treatment. The revised International Society for Human and Animal Mycology (ISHAM)-ABPA working group defines acute ABPA as either newly diagnosed ABPA or exacerbation and states that oral glucocorticoids are the most rapid-acting treatment for acute ABPA.

• #1 Treatment of allergic bronchopulmonary aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-allergic-bronchopulmonary-aspergillosis

  The use of antifungal agents, either in combination with glucocorticoids or as glucocorticoid alternatives, is more controversial. Due to the risk of adverse effects and interactions with glucocorticoid metabolism, we reserve antifungal therapy for those unable to taper oral glucocorticoids or who develop exacerbations despite glucocorticoid therapy. We typically use voriconazole because it is frequently better tolerated than itraconazole and is more studied in ABPA than the newer azole agents.

• #1 Aspergillus and Allergic Bronchopulmonary Aspergillosis | Cystic Fibrosis Foundation

  https://www.cff.org/managing-cf/aspergillus-and-allergic-bronchopulmonary-aspergillosis

  Treatment for ABPA involves prevention and treatment of acute episodes, or flare-ups. […] Treatment of ABPA has two parts. Inflammation in the lung is treated with corticosteroids. Fungal colonization is treated with antifungal medicines. […] Oral corticosteroid pills or liquid, such as prednisolone (brand names include Pediapred and Prelone), prednisone tablets, and methylprednisolone (brand names include Medrol) tablets, have anti-inflammatory effects. […] Antifungal medicines like itraconazole (brand names include Sporanox) reduce the amount of fungus in the lungs. […] Because steroids can have significant side effects and ABPA can be difficult to treat, CF providers may offer a therapy that targets one particular part of the immune system (so-called biologic therapies). One such therapy, omalizumab (Xolair), has been used to target IgE, which is often very elevated in patients with ABPA.

• #1 Allergic Bronchopulmonary Aspergillosis (ABPA)

  https://allergyasthmanetwork.org/news/allergic-bronchopulmonary-aspergillosis-abpa/

  Allergic bronchopulmonary aspergillosis treatment includes: […] Treatment goals for ABPA for people with asthma should focus on: […] Oral glucocorticoids remain the primary treatment for ABPA, normally tapered over a course of three months. Antifungal therapy may also be included in treatment for patients. […] Inhaled corticosteroids may be used as an add-on treatment but should not be used as first-line therapy. […] Allergic bronchopulmonary aspergillosis treatment includes: […] The initial treatment for ABPA is a course of oral glucocorticoids for 14 days, then tapered over a course of 3 months. […] Delaying treatment for ABPA may result in pulmonary fibrosis, bronchiectasis, chronic mucus production, and severe persistent asthma, and loss of lung function.

• #1 Aspergillosis: causes, types and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/aspergillosis-causes-types-and-treatment

  Aspergillosis: causes, types and treatment […] Aspergillus-related disease is rare, but results in high mortality rates. The limited treatment options and emerging antifungal drug resistance mean that accurate diagnosis and management is paramount. […] Aspergillus causes a broad range of diseases for which there are limited antifungal drug treatment options — a problem that is exacerbated by the emerging threat of antifungal drug resistance. As a result, there is a need for novel diagnostic and therapeutic approaches to improve patient outcomes. Pharmacists should be aware of the various side effects and drug interactions associated with the use of antifungal drugs in the treatment of Aspergillus-related disease. […] Treatment […] Voriconazole is recommended as first-line therapy for IPA, as it is associated with a lower mortality rate compared with amphotericin B. Isavuconazole is equally effective as voriconazole but less toxic. IPA should be treated with at least 12 weeks of antifungal therapy, although longer treatment courses may be required depending on clinical response and ongoing immunosuppression. Therapeutic drug monitoring is recommended during treatment with triazole antifungals. […] Long-term oral triazole therapy is the cornerstone of treatment for CPA. In cases of triazole intolerance or treatment failure, shorter courses of intravenous therapy with amphotericin B or an echinocandin may be used. Surgical management may be an option in CPA patients with localised disease. Many patients are deficient in gamma interferon (IFN) or interleukin 12 and benefit from gamma IFN supplementation. […] Short courses of systemic corticosteroids are used for exacerbations of ABPA, followed by long-term triazole therapy in many patients to reduce the fungal burden in those with frequent exacerbations or poorly controlled asthma. […] A four-month course of oral antifungal therapy is the mainstay of treatment for Aspergillus bronchitis. However, relapse is common (50%) and longer therapy may be required. […] Topical intranasal corticosteroids may help to treat AFRS and antifungals are only used in cases with relapsing disease. The treatment of aspergillosis varies depending on the specific disease.

• #1 Aspergillosis : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/aspergillosis?language=fr

  Invasive aspergillosis: First-line treatment is an azole antifungal agent such as voriconazole or isavuconazole, to be administered immediately if infection is suspected. Second-line treatments are posaconazole or amphotericin B. The emergence of Aspergillus resistant to these azole drugs is a growing problem in some countries as a result of widespread azole use in agriculture, but as yet it is not a cause for concern in France. Treatment should also involve management of the underlying disease and immune system boosting. […] Allergic bronchopulmonary aspergillosis: Treatment is based on the use of corticosteroids, sometimes in combination with an oral antifungal drug. […] Chronic pulmonary aspergillosis: Treatment depends on the size and location of the lesions. It can range from active monitoring to antifungal treatment or surgery. Hemoptysis (coughing up blood) is a warning sign that requires emergency medical attention and specific treatment.

• #1 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. […] This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

• #1 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Surgery for aspergillosis should be considered for localized disease that is easily accessible to debridement (eg, invasive fungal sinusitis or localized cutaneous disease) (strong recommendation; low-quality evidence). […] We recommend voriconazole as primary therapy for CNS aspergillosis (strong recommendation; moderate-quality evidence). […] We recommend that Aspergillus endophthalmitis be treated with systemic oral or intravenous voriconazole plus intravitreal voriconazole or intravitreal AmB deoxycholate (strong recommendation; weak-quality evidence). […] We recommend prophylaxis with posaconazole (strong recommendation; high-quality evidence), voriconazole (strong recommendation; moderate-quality evidence), and/or micafungin (weak recommendation; low-quality evidence) during prolonged neutropenia for those who are at high risk for IA (strong recommendation; high-quality evidence).

• #1 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #1

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Despite improvements in treatment and diagnostics over the last two decades, invasive aspergillosis (IA) remains a devastating fungal disease. […] Treatment options for IA currently consist of three classes of antifungals (azoles, polyenes, echinocandins) with distinctive advantages and shortcomings. […] Especially in settings of difficult to treat IA, comprising drug tolerance/resistance, limiting drug-drug interactions, and/or severe underlying organ dysfunction, novel approaches are urgently needed. […] Promising new drugs for the treatment of IA are in late-stage clinical development, including olorofim (a dihydroorotate dehydrogenase inhibitor), fosmanogepix (a Gwt1 enzyme inhibitor), ibrexafungerp (a triterpenoid), opelconazole (an azole optimized for inhalation) and rezafungin (an echinocandin with long half-life time).

• #1

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Current investigations show encouraging results, so far mostly in preclinical settings. […] Therapeutic measures for IA currently consist of three antifungal drug classes, namely azoles (voriconazole, posaconazole, isavuconazole), polyenes [liposomal amphotericin-B (LAmB), amphotericin-B lipid complex (ABLC)] and echinocandins (caspofungin, anidulafungin, micafungin). […] The emergence of azole-resistance, drug-drug interactions, and toxicity, is often limiting current therapeutic approaches. […] The future looks brighter however, with a number of new antifungals in development. […] In this review we briefly discuss the current therapy standards of IA, primarily focusing on its pulmonary manifestation. […] In case of intolerance or refractory disease after 7 days of therapy with a first-line antifungal, a switch of drug class, meaning a switch from an azole to LAmB in most cases, is recommended.

• #2 Aspergillosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/symptoms-causes/syc-20369619

  Depending on the type of aspergillosis, treatment may involve observation, antifungal medications or, in rare cases, surgery. […] In the case of invasive aspergillosis, prompt treatment is crucial. In some cases, treatment with antifungal medication begins as soon as aspergillosis is suspected, even before testing has confirmed the diagnosis.

• #2 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. […] Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. […] Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice. […] Early systemic antifungal treatment is of primary importance for survival against IA, while surgery plays an important role mainly in rarer disease manifestations of invasive disease including, e.g., sinusitis and osteomyelitis.

• #2 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend primary treatment with voriconazole (strong recommendation; high-quality evidence). […] Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence). […] Alternative therapies include liposomal AmB (strong recommendation; moderate-quality evidence), isavuconazole (strong recommendation; moderate-quality evidence), or other lipid formulations of AmB (weak recommendation; low-quality evidence). […] Combination antifungal therapy with voriconazole and an echinocandin may be considered in select patients with documented IPA (weak recommendation; moderate-quality evidence). […] Primary therapy with an echinocandin is not recommended (strong recommendation; moderate-quality evidence). Echinocandins (micafungin or caspofungin) can be used in settings in which azole and polyene antifungals are contraindicated (weak recommendation; moderate-quality evidence).

• #2

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Initiation of combination therapy with e.g. an echinocandin being an alternative. […] The echinocandins (caspofungin, anidulafungin, micafungin) are rarely used as monotherapy due to limited clinical efficacy, and therefore strongly recommended only in combination with other antifungals. […] As first-line therapy, the combination of antifungal agents is not primarily recommended. […] The duration of therapy should be primarily guided by clinical, microbiological, and radiographic response, with an absolute minimum treatment duration of 6 weeks, while most of the patients receive treatment for at least 12 weeks. […] The new antifungals have the potential to complement the existing antifungal repertoire, and thereby improve patient outcomes. […] Current and future treatment approaches are displayed in Fig. 1.

• #2 What Is Aspergillosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/aspergillus/

  Allergic forms of aspergillosis such as ABPA and allergic Aspergillus sinusitis typically heal with treatment and are generally not life-threatening. […] Invasive aspergillosis is a serious infection and can be a major cause of mortality in immunocompromised people. […] The duration of the diseases varies depending on underlying health issues, the severity or site of infection, and type of disease. […] Allergic forms, like ABPA, may require steroid and antifungal treatment for a few months, possibly longer. […] Invasive pulmonary aspergillosis may require treatment with an antifungal medication for at least 6 to 12 weeks. […] Severe forms may require lifelong treatment and monitoring to control the disease. […] In addition to early diagnosis, early treatment is critical in managing aspergillosis.

• #2 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend that treatment of IPA be continued for a minimum of 612 weeks, largely dependent on the degree and duration of immunosuppression, site of disease, and evidence of disease improvement (strong recommendation; low-quality evidence). […] For patients with successfully treated IPA who require subsequent immunosuppression, secondary prophylaxis should be initiated to prevent recurrence (strong recommendation; moderate-quality evidence). […] Reducing doses of, or eliminating altogether, immunosuppressive agents, when feasible, is advised as a component of anti-Aspergillus therapy (strong recommendation; low-quality evidence). […] Colony-stimulating factors may be considered in neutropenic patients with diagnosed or suspected IA (weak recommendation; low-quality evidence). […] Granulocyte transfusions can be considered for neutropenic patients with IA that is refractory or unlikely to respond to standard therapy, and for an anticipated duration of more than one week (weak recommendation; low-quality evidence).

• #2 Treatment of allergic bronchopulmonary aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-allergic-bronchopulmonary-aspergillosis

  Treatment of allergic bronchopulmonary aspergillosis (ABPA) aims to control episodes of acute inflammation and to limit progressive lung injury. The roles of systemic glucocorticoids and antifungal agents vary with the disease activity. Antifungal therapy may help to decrease exacerbations. Inhaled glucocorticoids may help control symptoms of asthma but do not have documented efficacy in preventing acute episodes of ABPA. […] For acute ABPA manifest by radiographic opacities (usually upper or middle lobes) and an elevated total serum IgE (generally >1000 international units/mL), systemic glucocorticoids are the mainstay of treatment. The revised International Society for Human and Animal Mycology (ISHAM)-ABPA working group defines acute ABPA as either newly diagnosed ABPA or exacerbation and states that oral glucocorticoids are the most rapid-acting treatment for acute ABPA.

• #2 Allergic Bronchopulmonary Aspergillosis (ABPA)

  https://allergyasthmanetwork.org/news/allergic-bronchopulmonary-aspergillosis-abpa/

  Allergic bronchopulmonary aspergillosis treatment includes: […] Treatment goals for ABPA for people with asthma should focus on: […] Oral glucocorticoids remain the primary treatment for ABPA, normally tapered over a course of three months. Antifungal therapy may also be included in treatment for patients. […] Inhaled corticosteroids may be used as an add-on treatment but should not be used as first-line therapy. […] Allergic bronchopulmonary aspergillosis treatment includes: […] The initial treatment for ABPA is a course of oral glucocorticoids for 14 days, then tapered over a course of 3 months. […] Delaying treatment for ABPA may result in pulmonary fibrosis, bronchiectasis, chronic mucus production, and severe persistent asthma, and loss of lung function.

• #2 Aspergillosis : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/aspergillosis?language=fr

  Invasive aspergillosis: First-line treatment is an azole antifungal agent such as voriconazole or isavuconazole, to be administered immediately if infection is suspected. Second-line treatments are posaconazole or amphotericin B. The emergence of Aspergillus resistant to these azole drugs is a growing problem in some countries as a result of widespread azole use in agriculture, but as yet it is not a cause for concern in France. Treatment should also involve management of the underlying disease and immune system boosting. […] Allergic bronchopulmonary aspergillosis: Treatment is based on the use of corticosteroids, sometimes in combination with an oral antifungal drug. […] Chronic pulmonary aspergillosis: Treatment depends on the size and location of the lesions. It can range from active monitoring to antifungal treatment or surgery. Hemoptysis (coughing up blood) is a warning sign that requires emergency medical attention and specific treatment.

• #2 Aspergillosis: Symptoms and treatment | Doctor

  https://patient.info/doctor/aspergillosis

  Management of ABPA is always decided in secondary care, using oral corticosteroids (OCS) and anti-fungals (itraconazole and voriconazole). Monoclonal antibodies such as omalizumab may also be used. […] Treatment is usually initiated when patients become symptomatic; it may include long-term oral itraconazole and/or surgical resection. […] Voriconazole is the treatment of choice. Posaconazole is an alternative. Amphotericin may be used if initial treatment fails. […] Early administration of voriconazole or itraconazole. […] Surgical resection may be considered for cases unresponsive to medical therapy. […] For both primary skin infection and that associated with invasive aspergillosis, treatment has traditionally been with high-dose intravenous amphotericin. Voriconazole, itraconazole and caspofungin are other treatments that are used. […] Inhaled amphotericin may be used for patients with solid organ transplants when Aspergillus spp. are cultured from sputum but there is no evidence of pneumonia. […] Research into the development of vaccines against aspergillosis is ongoing.

• #2 Aspergillosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/aspergillosis/

  Aspergillosis is a fungal infection caused by the Aspergillus species. […] Treatment may include systemic glucocorticoids to reduce inflammation, antifungal therapy (e.g., itraconazole or voriconazole), and/or surgical resection, depending on the clinical presentation. […] Promptly treat ABPA by decreasing the immune response through management and prevention of acute exacerbations and decreasing the fungal burden with antifungals. […] Oral glucocorticoids: e.g., prednisone to reduce the inflammatory response. […] Antifungal therapy: to reduce the fungal burden. […] Preferred: itraconazole. […] Alternatives include voriconazole (off-label). […] Delaying treatment of ABPA can lead to pulmonary fibrosis, chronic bronchiectasis, and permanent loss of lung function. […] Systemic antifungal therapy: Indications: symptomatic patients and/or those with radiographic progression or loss of lung function.

• #2 Aspergillosis: causes, types and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/aspergillosis-causes-types-and-treatment

  Aspergillosis: causes, types and treatment […] Aspergillus-related disease is rare, but results in high mortality rates. The limited treatment options and emerging antifungal drug resistance mean that accurate diagnosis and management is paramount. […] Aspergillus causes a broad range of diseases for which there are limited antifungal drug treatment options — a problem that is exacerbated by the emerging threat of antifungal drug resistance. As a result, there is a need for novel diagnostic and therapeutic approaches to improve patient outcomes. Pharmacists should be aware of the various side effects and drug interactions associated with the use of antifungal drugs in the treatment of Aspergillus-related disease. […] Treatment […] Voriconazole is recommended as first-line therapy for IPA, as it is associated with a lower mortality rate compared with amphotericin B. Isavuconazole is equally effective as voriconazole but less toxic. IPA should be treated with at least 12 weeks of antifungal therapy, although longer treatment courses may be required depending on clinical response and ongoing immunosuppression. Therapeutic drug monitoring is recommended during treatment with triazole antifungals. […] Long-term oral triazole therapy is the cornerstone of treatment for CPA. In cases of triazole intolerance or treatment failure, shorter courses of intravenous therapy with amphotericin B or an echinocandin may be used. Surgical management may be an option in CPA patients with localised disease. Many patients are deficient in gamma interferon (IFN) or interleukin 12 and benefit from gamma IFN supplementation. […] Short courses of systemic corticosteroids are used for exacerbations of ABPA, followed by long-term triazole therapy in many patients to reduce the fungal burden in those with frequent exacerbations or poorly controlled asthma. […] A four-month course of oral antifungal therapy is the mainstay of treatment for Aspergillus bronchitis. However, relapse is common (50%) and longer therapy may be required. […] Topical intranasal corticosteroids may help to treat AFRS and antifungals are only used in cases with relapsing disease. The treatment of aspergillosis varies depending on the specific disease.

• #2 Treatment of Aspergillosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30126229/

  Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. […] Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. […] Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. […] Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice.

• #2 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend antifungal prophylaxis with either a systemic triazole such as voriconazole or itraconazole or an inhaled AmB product for 3 to 4 months after lung transplant (strong recommendation; moderate-quality evidence). […] We suggest an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence). […] We recommend an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence).

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Aspergillosis-Treatment.aspx

  Aspergilloma with single fungal mass often do not need any treatment if asymptomatic. Regular X-ray scans are done to observe the growth and the spread, if any. In case the patient starts exhibiting the symptoms including blood in sputum, antifungal medications are prescribed. […] Allergic forms of aspergillosis are usually treated with oral triazoles. Allergic bronchopulmonary aspergillosis (ABPA) patients are given corticosteroids (oral or nasal) during the acute episodes. Addition of a triazole drug to the treatment regimen reduces the dose requirement of corticosteroids. […] Aspergillus bronchitis is generally treated with antifungal medications in an effective manner. Triazoles and (1,3)-d-glucan synthase inhibitors are often administered in the patients with aspergillus sinusitis. However, membrane fungicides remain to be the treatments of choice for aspergillus sinusitis. Surgical intervention is also needed in many cases to locate and eliminate the fungus.

• #2 Treating and Preventing Aspergillosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis/treatment

  In patients with milder forms of the disease who are experiencing fewer symptoms, the infection may not require treatment and eventually clear up on its own. […] If treatment is required, your doctors recommendation will depend on the type that is diagnosed. […] If you are diagnosed with allergic bronchopulmonary aspergillosis, an antifungal medication, such as itraconazole, is the most common course of action. […] For chronic pulmonary aspergillosis patients who develop a fungal ball, surgery is the best option if the mass is in a good location to be removed. […] In the most severe cases, a combination of antifungal medication and surgery may be necessary. […] If you have severe lung disease or a weakened immune system, you should take special precautions, such as minimizing your exposure to soil and dust. […] If you are at high risk, your doctor may suggest taking antifungal drugs as a preventive measure.

• #2 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. […] This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

• #2 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #2 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-16-4-145

  Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. […] Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. […] 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. […] Efficacy has been shown for first-line therapy of invasive aspergillosis with voriconazole and liposomal amphotericin B. […] Voriconazole is approved for 1st-line treatment of invasive aspergillosis, while posaconazole is approved for prophylaxis of invasive fungal infections and 2nd-line treatment of invasive aspergillosis.

• #2 Aspergillosis Basics | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/about/index.html

  Aspergillosis is an infection caused by breathing in spores of Aspergillus, a common mold. […] Treatment depends on the type of infection and usually includes an antifungal medication. […] Treatment depends on the type of infection and includes antifungal medications. Antimicrobial resistance is emerging in a type of Aspergillus called Aspergillus fumigatus (A. fumigatus) making it harder to treat. […] The fungus Aspergillus causes aspergillosis, a lung infection, in people with weakened immune systems. Antifungal-resistant aspergillosis is increasing.

• #2

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Current investigations show encouraging results, so far mostly in preclinical settings. […] Therapeutic measures for IA currently consist of three antifungal drug classes, namely azoles (voriconazole, posaconazole, isavuconazole), polyenes [liposomal amphotericin-B (LAmB), amphotericin-B lipid complex (ABLC)] and echinocandins (caspofungin, anidulafungin, micafungin). […] The emergence of azole-resistance, drug-drug interactions, and toxicity, is often limiting current therapeutic approaches. […] The future looks brighter however, with a number of new antifungals in development. […] In this review we briefly discuss the current therapy standards of IA, primarily focusing on its pulmonary manifestation. […] In case of intolerance or refractory disease after 7 days of therapy with a first-line antifungal, a switch of drug class, meaning a switch from an azole to LAmB in most cases, is recommended.

• #2 Current Promising Therapeutic Targets for Aspergillosis Treatment – Journal of Pure and Applied Microbiology

  https://microbiologyjournal.org/current-promising-therapeutic-targets-for-aspergillosis-treatment/

  We have summarized 33 novel therapeutic targets present in Aspergillus genome which may further facilitate the antifungal drug discovery. […] Currently Broad-Spectrum Triazoles, Liposomal Amphotericin B, and Echinocandins are being used for Aspergillosis treatment, while increasing resistance against known antifungals is a major concern. […] There is an urgent need to discover novel of antifungal agents with optimum safety and efficacy. […] This review summarizes different drug targets in Aspergillus genomes and implications of their inhibition.

• #3 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Voriconazole, available in tablet, IV, and suspension formulation, is approved for the treatment of IA, Candida infections, scedosporiosis, and furasiosis. […] Isavuconazole, available in capsule and IV formulation, is another triazole preferred for the treatment of IA. […] A number of studies have suggested that posaconazole, available in delayed-release tablets, oral suspension, and IV formulation, may be an option to treat refractory IA. […] The echinocandins, which inhibit -1,3-glucan synthesis in the cell wall of fungi, have also been investigated for the treatment of IA. […] Current recommendations are summarized in Table 2. The Infectious Diseases Society of America (IDSA) 2016 guidelines recommend voriconazole as first-line treatment for IA (AI recommendation) with liposomal amphotericin B and isavuconazole as alternative options (AII recommendation). […] While currently available guidelines are targeted towards a small number of high-resource countries, they mostly fail to provide guidance for low- and middle-income countries (LMICs).

• #3 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend primary treatment with voriconazole (strong recommendation; high-quality evidence). […] Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence). […] Alternative therapies include liposomal AmB (strong recommendation; moderate-quality evidence), isavuconazole (strong recommendation; moderate-quality evidence), or other lipid formulations of AmB (weak recommendation; low-quality evidence). […] Combination antifungal therapy with voriconazole and an echinocandin may be considered in select patients with documented IPA (weak recommendation; moderate-quality evidence). […] Primary therapy with an echinocandin is not recommended (strong recommendation; moderate-quality evidence). Echinocandins (micafungin or caspofungin) can be used in settings in which azole and polyene antifungals are contraindicated (weak recommendation; moderate-quality evidence).

• #3

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Initiation of combination therapy with e.g. an echinocandin being an alternative. […] The echinocandins (caspofungin, anidulafungin, micafungin) are rarely used as monotherapy due to limited clinical efficacy, and therefore strongly recommended only in combination with other antifungals. […] As first-line therapy, the combination of antifungal agents is not primarily recommended. […] The duration of therapy should be primarily guided by clinical, microbiological, and radiographic response, with an absolute minimum treatment duration of 6 weeks, while most of the patients receive treatment for at least 12 weeks. […] The new antifungals have the potential to complement the existing antifungal repertoire, and thereby improve patient outcomes. […] Current and future treatment approaches are displayed in Fig. 1.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Aspergillosis-Treatment.aspx

  Patients suffering from invasive aspergillosis are treated with antifungal medications such as (1,3)-d-glucan synthase inhibitors, triazoles, and membrane fungicidal drugs. […] Triazoles are generally considered superior to membrane fungicides for treating invasive aspergillosis. […] As a general rule, immunosuppressive medications are avoided as much as possible in the treatment of invasive aspergillosis. Physicians prescribe one or more medications after careful consideration of the pros and cons of each treatment and possible impact of the treatment on the particular patient. Severe cases may require surgery. The survival rate is reported to be more than 50% in the treated invasive aspergillosis patients, and 0% in the untreated patients.

• #3 Treatment of allergic bronchopulmonary aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-allergic-bronchopulmonary-aspergillosis

  Treatment of allergic bronchopulmonary aspergillosis (ABPA) aims to control episodes of acute inflammation and to limit progressive lung injury. The roles of systemic glucocorticoids and antifungal agents vary with the disease activity. Antifungal therapy may help to decrease exacerbations. Inhaled glucocorticoids may help control symptoms of asthma but do not have documented efficacy in preventing acute episodes of ABPA. […] For acute ABPA manifest by radiographic opacities (usually upper or middle lobes) and an elevated total serum IgE (generally >1000 international units/mL), systemic glucocorticoids are the mainstay of treatment. The revised International Society for Human and Animal Mycology (ISHAM)-ABPA working group defines acute ABPA as either newly diagnosed ABPA or exacerbation and states that oral glucocorticoids are the most rapid-acting treatment for acute ABPA.

• #3 Treating and Preventing Aspergillosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis/treatment

  In patients with milder forms of the disease who are experiencing fewer symptoms, the infection may not require treatment and eventually clear up on its own. […] If treatment is required, your doctors recommendation will depend on the type that is diagnosed. […] If you are diagnosed with allergic bronchopulmonary aspergillosis, an antifungal medication, such as itraconazole, is the most common course of action. […] For chronic pulmonary aspergillosis patients who develop a fungal ball, surgery is the best option if the mass is in a good location to be removed. […] In the most severe cases, a combination of antifungal medication and surgery may be necessary. […] If you have severe lung disease or a weakened immune system, you should take special precautions, such as minimizing your exposure to soil and dust. […] If you are at high risk, your doctor may suggest taking antifungal drugs as a preventive measure.

• #3 Aspergillus and Allergic Bronchopulmonary Aspergillosis | Cystic Fibrosis Foundation

  https://www.cff.org/managing-cf/aspergillus-and-allergic-bronchopulmonary-aspergillosis

  Treatment for ABPA involves prevention and treatment of acute episodes, or flare-ups. […] Treatment of ABPA has two parts. Inflammation in the lung is treated with corticosteroids. Fungal colonization is treated with antifungal medicines. […] Oral corticosteroid pills or liquid, such as prednisolone (brand names include Pediapred and Prelone), prednisone tablets, and methylprednisolone (brand names include Medrol) tablets, have anti-inflammatory effects. […] Antifungal medicines like itraconazole (brand names include Sporanox) reduce the amount of fungus in the lungs. […] Because steroids can have significant side effects and ABPA can be difficult to treat, CF providers may offer a therapy that targets one particular part of the immune system (so-called biologic therapies). One such therapy, omalizumab (Xolair), has been used to target IgE, which is often very elevated in patients with ABPA.

• #3 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. […] Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. […] Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice. […] Early systemic antifungal treatment is of primary importance for survival against IA, while surgery plays an important role mainly in rarer disease manifestations of invasive disease including, e.g., sinusitis and osteomyelitis.

• #3 Aspergillosis: causes, types and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/aspergillosis-causes-types-and-treatment

  Aspergillosis: causes, types and treatment […] Aspergillus-related disease is rare, but results in high mortality rates. The limited treatment options and emerging antifungal drug resistance mean that accurate diagnosis and management is paramount. […] Aspergillus causes a broad range of diseases for which there are limited antifungal drug treatment options — a problem that is exacerbated by the emerging threat of antifungal drug resistance. As a result, there is a need for novel diagnostic and therapeutic approaches to improve patient outcomes. Pharmacists should be aware of the various side effects and drug interactions associated with the use of antifungal drugs in the treatment of Aspergillus-related disease. […] Treatment […] Voriconazole is recommended as first-line therapy for IPA, as it is associated with a lower mortality rate compared with amphotericin B. Isavuconazole is equally effective as voriconazole but less toxic. IPA should be treated with at least 12 weeks of antifungal therapy, although longer treatment courses may be required depending on clinical response and ongoing immunosuppression. Therapeutic drug monitoring is recommended during treatment with triazole antifungals. […] Long-term oral triazole therapy is the cornerstone of treatment for CPA. In cases of triazole intolerance or treatment failure, shorter courses of intravenous therapy with amphotericin B or an echinocandin may be used. Surgical management may be an option in CPA patients with localised disease. Many patients are deficient in gamma interferon (IFN) or interleukin 12 and benefit from gamma IFN supplementation. […] Short courses of systemic corticosteroids are used for exacerbations of ABPA, followed by long-term triazole therapy in many patients to reduce the fungal burden in those with frequent exacerbations or poorly controlled asthma. […] A four-month course of oral antifungal therapy is the mainstay of treatment for Aspergillus bronchitis. However, relapse is common (50%) and longer therapy may be required. […] Topical intranasal corticosteroids may help to treat AFRS and antifungals are only used in cases with relapsing disease. The treatment of aspergillosis varies depending on the specific disease.

• #3 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  Aspergillosis treatments vary with the type of disease. Possible treatments include: […] Simple, single aspergillomas often don’t need treatment, and medications aren’t usually effective in treating these fungal masses. Instead, aspergillomas that don’t cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medications may be recommended. […] The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from worsening. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren’t helpful for allergic bronchopulmonary aspergillosis, but they may be combined with corticosteroids to reduce the dose of steroids and improve lung function. […] These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option.

• #3 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. […] This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

• #3 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Surgery for aspergillosis should be considered for localized disease that is easily accessible to debridement (eg, invasive fungal sinusitis or localized cutaneous disease) (strong recommendation; low-quality evidence). […] We recommend voriconazole as primary therapy for CNS aspergillosis (strong recommendation; moderate-quality evidence). […] We recommend that Aspergillus endophthalmitis be treated with systemic oral or intravenous voriconazole plus intravitreal voriconazole or intravitreal AmB deoxycholate (strong recommendation; weak-quality evidence). […] We recommend prophylaxis with posaconazole (strong recommendation; high-quality evidence), voriconazole (strong recommendation; moderate-quality evidence), and/or micafungin (weak recommendation; low-quality evidence) during prolonged neutropenia for those who are at high risk for IA (strong recommendation; high-quality evidence).

• #3 Aspergillosis Basics | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/about/index.html

  Aspergillosis is an infection caused by breathing in spores of Aspergillus, a common mold. […] Treatment depends on the type of infection and usually includes an antifungal medication. […] Treatment depends on the type of infection and includes antifungal medications. Antimicrobial resistance is emerging in a type of Aspergillus called Aspergillus fumigatus (A. fumigatus) making it harder to treat. […] The fungus Aspergillus causes aspergillosis, a lung infection, in people with weakened immune systems. Antifungal-resistant aspergillosis is increasing.

• #3

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Despite improvements in treatment and diagnostics over the last two decades, invasive aspergillosis (IA) remains a devastating fungal disease. […] Treatment options for IA currently consist of three classes of antifungals (azoles, polyenes, echinocandins) with distinctive advantages and shortcomings. […] Especially in settings of difficult to treat IA, comprising drug tolerance/resistance, limiting drug-drug interactions, and/or severe underlying organ dysfunction, novel approaches are urgently needed. […] Promising new drugs for the treatment of IA are in late-stage clinical development, including olorofim (a dihydroorotate dehydrogenase inhibitor), fosmanogepix (a Gwt1 enzyme inhibitor), ibrexafungerp (a triterpenoid), opelconazole (an azole optimized for inhalation) and rezafungin (an echinocandin with long half-life time).

• #4 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend primary treatment with voriconazole (strong recommendation; high-quality evidence). […] Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence). […] Alternative therapies include liposomal AmB (strong recommendation; moderate-quality evidence), isavuconazole (strong recommendation; moderate-quality evidence), or other lipid formulations of AmB (weak recommendation; low-quality evidence). […] Combination antifungal therapy with voriconazole and an echinocandin may be considered in select patients with documented IPA (weak recommendation; moderate-quality evidence). […] Primary therapy with an echinocandin is not recommended (strong recommendation; moderate-quality evidence). Echinocandins (micafungin or caspofungin) can be used in settings in which azole and polyene antifungals are contraindicated (weak recommendation; moderate-quality evidence).

• #4

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Initiation of combination therapy with e.g. an echinocandin being an alternative. […] The echinocandins (caspofungin, anidulafungin, micafungin) are rarely used as monotherapy due to limited clinical efficacy, and therefore strongly recommended only in combination with other antifungals. […] As first-line therapy, the combination of antifungal agents is not primarily recommended. […] The duration of therapy should be primarily guided by clinical, microbiological, and radiographic response, with an absolute minimum treatment duration of 6 weeks, while most of the patients receive treatment for at least 12 weeks. […] The new antifungals have the potential to complement the existing antifungal repertoire, and thereby improve patient outcomes. […] Current and future treatment approaches are displayed in Fig. 1.

• #4 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend that treatment of IPA be continued for a minimum of 612 weeks, largely dependent on the degree and duration of immunosuppression, site of disease, and evidence of disease improvement (strong recommendation; low-quality evidence). […] For patients with successfully treated IPA who require subsequent immunosuppression, secondary prophylaxis should be initiated to prevent recurrence (strong recommendation; moderate-quality evidence). […] Reducing doses of, or eliminating altogether, immunosuppressive agents, when feasible, is advised as a component of anti-Aspergillus therapy (strong recommendation; low-quality evidence). […] Colony-stimulating factors may be considered in neutropenic patients with diagnosed or suspected IA (weak recommendation; low-quality evidence). […] Granulocyte transfusions can be considered for neutropenic patients with IA that is refractory or unlikely to respond to standard therapy, and for an anticipated duration of more than one week (weak recommendation; low-quality evidence).

• #4 Allergic Bronchopulmonary Aspergillosis (ABPA)

  https://allergyasthmanetwork.org/news/allergic-bronchopulmonary-aspergillosis-abpa/

  Allergic bronchopulmonary aspergillosis treatment includes: […] Treatment goals for ABPA for people with asthma should focus on: […] Oral glucocorticoids remain the primary treatment for ABPA, normally tapered over a course of three months. Antifungal therapy may also be included in treatment for patients. […] Inhaled corticosteroids may be used as an add-on treatment but should not be used as first-line therapy. […] Allergic bronchopulmonary aspergillosis treatment includes: […] The initial treatment for ABPA is a course of oral glucocorticoids for 14 days, then tapered over a course of 3 months. […] Delaying treatment for ABPA may result in pulmonary fibrosis, bronchiectasis, chronic mucus production, and severe persistent asthma, and loss of lung function.

• #4 Aspergillosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/aspergillosis/

  Aspergillosis is a fungal infection caused by the Aspergillus species. […] Treatment may include systemic glucocorticoids to reduce inflammation, antifungal therapy (e.g., itraconazole or voriconazole), and/or surgical resection, depending on the clinical presentation. […] Promptly treat ABPA by decreasing the immune response through management and prevention of acute exacerbations and decreasing the fungal burden with antifungals. […] Oral glucocorticoids: e.g., prednisone to reduce the inflammatory response. […] Antifungal therapy: to reduce the fungal burden. […] Preferred: itraconazole. […] Alternatives include voriconazole (off-label). […] Delaying treatment of ABPA can lead to pulmonary fibrosis, chronic bronchiectasis, and permanent loss of lung function. […] Systemic antifungal therapy: Indications: symptomatic patients and/or those with radiographic progression or loss of lung function.

• #4 Aspergillosis: Symptoms and treatment | Doctor

  https://patient.info/doctor/aspergillosis

  Management of ABPA is always decided in secondary care, using oral corticosteroids (OCS) and anti-fungals (itraconazole and voriconazole). Monoclonal antibodies such as omalizumab may also be used. […] Treatment is usually initiated when patients become symptomatic; it may include long-term oral itraconazole and/or surgical resection. […] Voriconazole is the treatment of choice. Posaconazole is an alternative. Amphotericin may be used if initial treatment fails. […] Early administration of voriconazole or itraconazole. […] Surgical resection may be considered for cases unresponsive to medical therapy. […] For both primary skin infection and that associated with invasive aspergillosis, treatment has traditionally been with high-dose intravenous amphotericin. Voriconazole, itraconazole and caspofungin are other treatments that are used. […] Inhaled amphotericin may be used for patients with solid organ transplants when Aspergillus spp. are cultured from sputum but there is no evidence of pneumonia. […] Research into the development of vaccines against aspergillosis is ongoing.

• #4 Aspergillosis – Types, Causes, Symptoms, Diagnosis, Treatment and Prevention

  https://www.medindia.net/health/conditions/aspergillosis.htm

  Antifungal compounds used for the treatment of invasive aspergillosis, […] Oral Itraconazole is an antifungal drug available as a capsule that helps to stabilize the clinical and radiological manifestations in patients with CPA. […] Voriconazole and D-AMB (deoxycholate amphotericin B) are drugs approved for primary treatment of invasive aspergillosis in the United States. Voriconazole is available as a tablet and as a solution for IV administration and is usually preferred. Liposomal formulations of amphotericin B are also available. […] Posaconazole is structurally similar to itraconazole and helps in prevention of invasive aspergillosis in certain neutropenic patients (patients with low white blood cell counts) or in patients with graft versus host disease. […] Studies suggest that there is patient-to-patient variability in the levels of drugs like itraconazole or voriconazole used for treatment or prevention of aspergillosis, which highlights the need for monitoring the drug levels in the blood via therapeutic drug monitoring. The necessity of therapeutic drug monitoring should be individualized depending on the clinical status of the patient and the overall treatment plans.

• #4 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. […] This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

• #4 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  Aspergillosis treatments vary with the type of disease. Possible treatments include: […] Simple, single aspergillomas often don’t need treatment, and medications aren’t usually effective in treating these fungal masses. Instead, aspergillomas that don’t cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medications may be recommended. […] The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from worsening. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren’t helpful for allergic bronchopulmonary aspergillosis, but they may be combined with corticosteroids to reduce the dose of steroids and improve lung function. […] These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option.

• #4 What Is Aspergillosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/aspergillus/

  Depending on the type of disease, you may have the following treatments: Observation, Oral Corticosteroids, Antifungal Medications, Surgery. […] Antifungal medications don’t penetrate an aspergilloma very effectively so surgery may be used to remove the fungal mass when an aspergilloma causes bleeding in the lungs.

• #4 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-16-4-145

  Echinocandins inhibit the synthesis of 1,3–D-glucan, an essential component of the fungal cell wall. […] Caspofungin, Micafungin and Anidulafungin are approved for antifungal treatment in the EU. […] With the introduction of these new and safer antifungals with a proven efficacy against aspergillosis prophylaxis has become a major issue and reasonable field for clinical investigation. […] Posaconazole 600 mg/d is strongly recommended in patients with acute myelogenous leukemia/myelodysplastic syndromes or undergoing allogeneic stem cell recipients with graft versus host disease for the prevention of invasive fungal infections and attributable mortality of invasive aspergillosis (Level A I). […] Voriconazole has a broad antifungal efficacy, including Aspergillus species. […] Since that trial voriconazole has been adopted gold standard for the treatment of invasive Aspergillosis.

• #4 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #4 TREATMENT OF ASPERGILLOSIS – Mycology Advocacy, Research & Education (MyCARE)

  https://fightfungus.org/treatment-of-aspergillosis/

  Prompt diagnosis and management of invasive aspergillosis improve outcomes. […] Antifungal-resistant aspergillosis is becoming a bigger problem. […] Many of the patients receiving antifungal medications for invasive aspergillosis have weakened immune systems or are very sick. […] Antifungal resistance means fungi can resist or evade the effects of the drugs used to kill them. […] Patients with azole-resistant Aspergillus fumigatus infections are 33% more likely to die, compared with patients with Aspergillus fumigatus infections that can be treated with azoles. […] In this section, we go over the drugs and other treatments used to manage aspergillosis, with a brief discussion of investigational therapies as well. […] Triazoles are the most commonly used drugs for invasive aspergillosis.

• #4 Aspergillosis: Symptoms, Causes, Types, and Treatment

  https://www.verywellhealth.com/aspergillosis-5219056

  Antifungal drugs are the standard treatment for invasive pulmonary aspergillosis, the most common type of aspergillosis infection. […] Vfend (voriconazole) is the treatment of choice but isavuconazole and posaconazole have similar efficacy with less toxicity. […] Amphotericin B is another option if antifungals are not effective. […] Combination therapy is used with extensive infection and in severe immunosuppression. […] All antifungal drugs can have serious side effects, including kidney and liver damage. […] Of note, treating any underlying conditions, especially those that weaken the immune system, may increase the effectiveness of your antifungal treatment.

• #4 Using Expanded Natural Killer Cells as Therapy for Invasive Aspergillosis

  https://www.mdpi.com/2309-608X/6/4/231

  Using Expanded Natural Killer Cells as Therapy for Invasive Aspergillosis […] Invasive aspergillosis (IA) is a major opportunistic fungal infection in patients with haematological malignancies. […] This raises the consideration for immunotherapy as an adjunctive treatment. […] In this study, we evaluated the utility of expanded human NK cells as treatment against Aspergillus fumigatus infection in vitro and in vivo. […] The efficacy of these cells was investigated in A. fumigatus killing assays in vitro and as adoptive cellular therapy in vivo. […] In an immunocompromised mice pulmonary aspergillosis model, we showed that NK cell treatment significantly reduced fungal burden, hence demonstrating the translational potential of expanded NK cells as adjunctive therapy against IA in immunocompromised patients.

• #5 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Voriconazole, available in tablet, IV, and suspension formulation, is approved for the treatment of IA, Candida infections, scedosporiosis, and furasiosis. […] Isavuconazole, available in capsule and IV formulation, is another triazole preferred for the treatment of IA. […] A number of studies have suggested that posaconazole, available in delayed-release tablets, oral suspension, and IV formulation, may be an option to treat refractory IA. […] The echinocandins, which inhibit -1,3-glucan synthesis in the cell wall of fungi, have also been investigated for the treatment of IA. […] Current recommendations are summarized in Table 2. The Infectious Diseases Society of America (IDSA) 2016 guidelines recommend voriconazole as first-line treatment for IA (AI recommendation) with liposomal amphotericin B and isavuconazole as alternative options (AII recommendation). […] While currently available guidelines are targeted towards a small number of high-resource countries, they mostly fail to provide guidance for low- and middle-income countries (LMICs).

• #5 Management of Invasive Aspergillosis

  https://www.uspharmacist.com/article/management-of-invasive-aspergillosis

  The IDSA guidelines do not recommend combination therapy for the initial treatment of IA. Instead, salvage therapy is recommended only if there is no clinical response to initial therapy. Consequently, this may involve adding a second agent or switching to another medication. […] The IDSA guidelines recommend the use of posaconazole for prophylaxis of IA. This recommendation is based on two randomized, controlled, multicenter trials that evaluated the prophylactic use of posaconazole in patients with neutropenia and GvHD.

• #5 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend that treatment of IPA be continued for a minimum of 612 weeks, largely dependent on the degree and duration of immunosuppression, site of disease, and evidence of disease improvement (strong recommendation; low-quality evidence). […] For patients with successfully treated IPA who require subsequent immunosuppression, secondary prophylaxis should be initiated to prevent recurrence (strong recommendation; moderate-quality evidence). […] Reducing doses of, or eliminating altogether, immunosuppressive agents, when feasible, is advised as a component of anti-Aspergillus therapy (strong recommendation; low-quality evidence). […] Colony-stimulating factors may be considered in neutropenic patients with diagnosed or suspected IA (weak recommendation; low-quality evidence). […] Granulocyte transfusions can be considered for neutropenic patients with IA that is refractory or unlikely to respond to standard therapy, and for an anticipated duration of more than one week (weak recommendation; low-quality evidence).

• #5 Allergic Bronchopulmonary Aspergillosis (ABPA)

  https://allergyasthmanetwork.org/news/allergic-bronchopulmonary-aspergillosis-abpa/

  Allergic bronchopulmonary aspergillosis treatment includes: […] Treatment goals for ABPA for people with asthma should focus on: […] Oral glucocorticoids remain the primary treatment for ABPA, normally tapered over a course of three months. Antifungal therapy may also be included in treatment for patients. […] Inhaled corticosteroids may be used as an add-on treatment but should not be used as first-line therapy. […] Allergic bronchopulmonary aspergillosis treatment includes: […] The initial treatment for ABPA is a course of oral glucocorticoids for 14 days, then tapered over a course of 3 months. […] Delaying treatment for ABPA may result in pulmonary fibrosis, bronchiectasis, chronic mucus production, and severe persistent asthma, and loss of lung function.

• #5 Treatment of allergic bronchopulmonary aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-allergic-bronchopulmonary-aspergillosis

  The use of antifungal agents, either in combination with glucocorticoids or as glucocorticoid alternatives, is more controversial. Due to the risk of adverse effects and interactions with glucocorticoid metabolism, we reserve antifungal therapy for those unable to taper oral glucocorticoids or who develop exacerbations despite glucocorticoid therapy. We typically use voriconazole because it is frequently better tolerated than itraconazole and is more studied in ABPA than the newer azole agents.

• #5 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. […] Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. […] Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice. […] Early systemic antifungal treatment is of primary importance for survival against IA, while surgery plays an important role mainly in rarer disease manifestations of invasive disease including, e.g., sinusitis and osteomyelitis.

• #5 Treating and Preventing Aspergillosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis/treatment

  In patients with milder forms of the disease who are experiencing fewer symptoms, the infection may not require treatment and eventually clear up on its own. […] If treatment is required, your doctors recommendation will depend on the type that is diagnosed. […] If you are diagnosed with allergic bronchopulmonary aspergillosis, an antifungal medication, such as itraconazole, is the most common course of action. […] For chronic pulmonary aspergillosis patients who develop a fungal ball, surgery is the best option if the mass is in a good location to be removed. […] In the most severe cases, a combination of antifungal medication and surgery may be necessary. […] If you have severe lung disease or a weakened immune system, you should take special precautions, such as minimizing your exposure to soil and dust. […] If you are at high risk, your doctor may suggest taking antifungal drugs as a preventive measure.

• #5 Aspergillosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/fungi/aspergillosis

  Aspergillomas neither require nor respond to systemic antifungal therapy but may require resection because of local effects, especially hemoptysis. […] Prophylaxis with posaconazole or itraconazole can be considered for high-risk patients (those with graft-vs-host disease or neutropenia due to acute myelocytic leukemia). […] Treat invasive infections with voriconazole, posaconazole or isavuconazonium; amphotericin B is an alternative.

• #5 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. […] This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

• #5 Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin – review of the literature | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-16-4-145

  Echinocandins inhibit the synthesis of 1,3–D-glucan, an essential component of the fungal cell wall. […] Caspofungin, Micafungin and Anidulafungin are approved for antifungal treatment in the EU. […] With the introduction of these new and safer antifungals with a proven efficacy against aspergillosis prophylaxis has become a major issue and reasonable field for clinical investigation. […] Posaconazole 600 mg/d is strongly recommended in patients with acute myelogenous leukemia/myelodysplastic syndromes or undergoing allogeneic stem cell recipients with graft versus host disease for the prevention of invasive fungal infections and attributable mortality of invasive aspergillosis (Level A I). […] Voriconazole has a broad antifungal efficacy, including Aspergillus species. […] Since that trial voriconazole has been adopted gold standard for the treatment of invasive Aspergillosis.

• #5 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Surgery for aspergillosis should be considered for localized disease that is easily accessible to debridement (eg, invasive fungal sinusitis or localized cutaneous disease) (strong recommendation; low-quality evidence). […] We recommend voriconazole as primary therapy for CNS aspergillosis (strong recommendation; moderate-quality evidence). […] We recommend that Aspergillus endophthalmitis be treated with systemic oral or intravenous voriconazole plus intravitreal voriconazole or intravitreal AmB deoxycholate (strong recommendation; weak-quality evidence). […] We recommend prophylaxis with posaconazole (strong recommendation; high-quality evidence), voriconazole (strong recommendation; moderate-quality evidence), and/or micafungin (weak recommendation; low-quality evidence) during prolonged neutropenia for those who are at high risk for IA (strong recommendation; high-quality evidence).

• #5 Aspergillosis : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/aspergillosis?language=fr

  Invasive aspergillosis: First-line treatment is an azole antifungal agent such as voriconazole or isavuconazole, to be administered immediately if infection is suspected. Second-line treatments are posaconazole or amphotericin B. The emergence of Aspergillus resistant to these azole drugs is a growing problem in some countries as a result of widespread azole use in agriculture, but as yet it is not a cause for concern in France. Treatment should also involve management of the underlying disease and immune system boosting. […] Allergic bronchopulmonary aspergillosis: Treatment is based on the use of corticosteroids, sometimes in combination with an oral antifungal drug. […] Chronic pulmonary aspergillosis: Treatment depends on the size and location of the lesions. It can range from active monitoring to antifungal treatment or surgery. Hemoptysis (coughing up blood) is a warning sign that requires emergency medical attention and specific treatment.

• #5

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Incremental insight into the pathophysiology of IA starts to create traction for immunotherapy as add-on treatment or prophylaxis. […] Given the hyperinflammatory environment in the lungs of patients with influenza- or COVID-19-associated pulmonary aspergillosis (IAPA or CAPA), immunotherapy results obtained in classically immunocompromised mice or EORTC/MSGERC host factor positive IA patients are not readily translatable to IAPA/CAPA patients. […] High-quality clinical trials with the most promising candidates are therefore urgently needed to enable regular evidence-based use of immunomodulation as add-on therapy in IA.

• #6 Aspergillosis: causes, types and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/aspergillosis-causes-types-and-treatment

  Aspergillosis: causes, types and treatment […] Aspergillus-related disease is rare, but results in high mortality rates. The limited treatment options and emerging antifungal drug resistance mean that accurate diagnosis and management is paramount. […] Aspergillus causes a broad range of diseases for which there are limited antifungal drug treatment options — a problem that is exacerbated by the emerging threat of antifungal drug resistance. As a result, there is a need for novel diagnostic and therapeutic approaches to improve patient outcomes. Pharmacists should be aware of the various side effects and drug interactions associated with the use of antifungal drugs in the treatment of Aspergillus-related disease. […] Treatment […] Voriconazole is recommended as first-line therapy for IPA, as it is associated with a lower mortality rate compared with amphotericin B. Isavuconazole is equally effective as voriconazole but less toxic. IPA should be treated with at least 12 weeks of antifungal therapy, although longer treatment courses may be required depending on clinical response and ongoing immunosuppression. Therapeutic drug monitoring is recommended during treatment with triazole antifungals. […] Long-term oral triazole therapy is the cornerstone of treatment for CPA. In cases of triazole intolerance or treatment failure, shorter courses of intravenous therapy with amphotericin B or an echinocandin may be used. Surgical management may be an option in CPA patients with localised disease. Many patients are deficient in gamma interferon (IFN) or interleukin 12 and benefit from gamma IFN supplementation. […] Short courses of systemic corticosteroids are used for exacerbations of ABPA, followed by long-term triazole therapy in many patients to reduce the fungal burden in those with frequent exacerbations or poorly controlled asthma. […] A four-month course of oral antifungal therapy is the mainstay of treatment for Aspergillus bronchitis. However, relapse is common (50%) and longer therapy may be required. […] Topical intranasal corticosteroids may help to treat AFRS and antifungals are only used in cases with relapsing disease. The treatment of aspergillosis varies depending on the specific disease.

• #6 Treatment of Aspergillosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30126229/

  Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. […] Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. […] Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. […] Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice.

• #6

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Initiation of combination therapy with e.g. an echinocandin being an alternative. […] The echinocandins (caspofungin, anidulafungin, micafungin) are rarely used as monotherapy due to limited clinical efficacy, and therefore strongly recommended only in combination with other antifungals. […] As first-line therapy, the combination of antifungal agents is not primarily recommended. […] The duration of therapy should be primarily guided by clinical, microbiological, and radiographic response, with an absolute minimum treatment duration of 6 weeks, while most of the patients receive treatment for at least 12 weeks. […] The new antifungals have the potential to complement the existing antifungal repertoire, and thereby improve patient outcomes. […] Current and future treatment approaches are displayed in Fig. 1.

• #6 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Surgery for aspergillosis should be considered for localized disease that is easily accessible to debridement (eg, invasive fungal sinusitis or localized cutaneous disease) (strong recommendation; low-quality evidence). […] We recommend voriconazole as primary therapy for CNS aspergillosis (strong recommendation; moderate-quality evidence). […] We recommend that Aspergillus endophthalmitis be treated with systemic oral or intravenous voriconazole plus intravitreal voriconazole or intravitreal AmB deoxycholate (strong recommendation; weak-quality evidence). […] We recommend prophylaxis with posaconazole (strong recommendation; high-quality evidence), voriconazole (strong recommendation; moderate-quality evidence), and/or micafungin (weak recommendation; low-quality evidence) during prolonged neutropenia for those who are at high risk for IA (strong recommendation; high-quality evidence).

• #6 Aspergillus and Allergic Bronchopulmonary Aspergillosis | Cystic Fibrosis Foundation

  https://www.cff.org/managing-cf/aspergillus-and-allergic-bronchopulmonary-aspergillosis

  Treatment for ABPA involves prevention and treatment of acute episodes, or flare-ups. […] Treatment of ABPA has two parts. Inflammation in the lung is treated with corticosteroids. Fungal colonization is treated with antifungal medicines. […] Oral corticosteroid pills or liquid, such as prednisolone (brand names include Pediapred and Prelone), prednisone tablets, and methylprednisolone (brand names include Medrol) tablets, have anti-inflammatory effects. […] Antifungal medicines like itraconazole (brand names include Sporanox) reduce the amount of fungus in the lungs. […] Because steroids can have significant side effects and ABPA can be difficult to treat, CF providers may offer a therapy that targets one particular part of the immune system (so-called biologic therapies). One such therapy, omalizumab (Xolair), has been used to target IgE, which is often very elevated in patients with ABPA.

• #6 Treatment of allergic bronchopulmonary aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-of-allergic-bronchopulmonary-aspergillosis

  The use of antifungal agents, either in combination with glucocorticoids or as glucocorticoid alternatives, is more controversial. Due to the risk of adverse effects and interactions with glucocorticoid metabolism, we reserve antifungal therapy for those unable to taper oral glucocorticoids or who develop exacerbations despite glucocorticoid therapy. We typically use voriconazole because it is frequently better tolerated than itraconazole and is more studied in ABPA than the newer azole agents.

• #6 Aspergillosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/aspergillosis/

  Aspergillosis is a fungal infection caused by the Aspergillus species. […] Treatment may include systemic glucocorticoids to reduce inflammation, antifungal therapy (e.g., itraconazole or voriconazole), and/or surgical resection, depending on the clinical presentation. […] Promptly treat ABPA by decreasing the immune response through management and prevention of acute exacerbations and decreasing the fungal burden with antifungals. […] Oral glucocorticoids: e.g., prednisone to reduce the inflammatory response. […] Antifungal therapy: to reduce the fungal burden. […] Preferred: itraconazole. […] Alternatives include voriconazole (off-label). […] Delaying treatment of ABPA can lead to pulmonary fibrosis, chronic bronchiectasis, and permanent loss of lung function. […] Systemic antifungal therapy: Indications: symptomatic patients and/or those with radiographic progression or loss of lung function.

• #6 Aspergillosis

  https://www.nhs.uk/conditions/aspergillosis/

  Treatment for aspergillosis depends on the type you have and usually aims to help control the symptoms. […] If it’s not treated or well controlled, there’s a risk it could damage your lungs. […] Treatments for common types of aspergillosis Common types Treatment Allergic bronchopulmonary aspergillosis or ABPA (an allergy to aspergillus mould) Steroid tablets and antifungal tablets Chronic pulmonary aspergillosis or CPA (a long-term lung infection) Long-term (possibly lifelong) treatment with antifungal tablets Aspergilloma (a ball of mould in the lungs, often linked to CPA) Surgery to remove the ball if it’s causing symptoms, often after antifungal treatment Invasive pulmonary aspergillus or IPA (a life-threatening infection in people with a weakened immune system) Antifungal medicine given directly into a vein in hospital.

• #6 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  Aspergillosis treatments vary with the type of disease. Possible treatments include: […] Simple, single aspergillomas often don’t need treatment, and medications aren’t usually effective in treating these fungal masses. Instead, aspergillomas that don’t cause symptoms may simply be closely monitored by chest X-ray. If the condition progresses, then antifungal medications may be recommended. […] The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from worsening. The best way to do this is with oral corticosteroids. Antifungal medications by themselves aren’t helpful for allergic bronchopulmonary aspergillosis, but they may be combined with corticosteroids to reduce the dose of steroids and improve lung function. […] These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option.

• #6 Aspergillosis: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14770-aspergillosis

  Aspergillosis is a group of illnesses caused by Aspergillus fungi. […] Treatments include surgery and antifungal medications. […] How is aspergillosis treated? […] Surgery, antifungal medications and corticosteroids are the most common treatment options. […] Surgery can often cure aspergillosis caused by a single fungus ball. […] Antifungal medications treat many kinds of aspergillosis. […] Possible antifungal treatments include: Voriconazole, isavuconazole, posaconazole or itraconazole. […] Corticosteroids (like prednisone, prednisolone and methylprednisolone) reduce inflammation. […] Surgery or antifungals can cure some types of noninvasive aspergillosis. […] Invasive aspergillosis can be very hard to cure.

• #6 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend antifungal prophylaxis with either a systemic triazole such as voriconazole or itraconazole or an inhaled AmB product for 3 to 4 months after lung transplant (strong recommendation; moderate-quality evidence). […] We suggest an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence). […] We recommend an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence).

• #6 Avian Aspergillosis: What Every Veterinarian Needs to Know | Today’s Veterinary Practice

  https://todaysveterinarypractice.com/exotic-medicine/avian-aspergillosis/

  Antifungal therapy is typically prolonged and can last several months. Routes of administration include nebulization, oral, parenteral, and topical. Medications of choice include amphotericin B, itraconazole, fluconazole, clotrimazole, and terbinafine hydrochloride. Ideally, antifungal choice should be based on a sensitivity test. Dr. Mayer uses the Fungal Testing Laboratory at the University of Texas in San Antonio to verify that the fungus is susceptible to the chosen antifungal agent. […] Amphotericin B can act as a fungistatic or fungicidal depending on its dosage, and it must be diluted with water before administration. It can be systemically toxic because it binds to cholesterol. Because of poor bioavailability, it must be given via the IV route. A variety of dosages can be given. Amphotericin B is the drug of choice that can be administered directly into the granuloma during endoscopic evaluation.

• #6 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #6 Aspergillosis: Symptoms and treatment | Doctor

  https://patient.info/doctor/aspergillosis

  Management of ABPA is always decided in secondary care, using oral corticosteroids (OCS) and anti-fungals (itraconazole and voriconazole). Monoclonal antibodies such as omalizumab may also be used. […] Treatment is usually initiated when patients become symptomatic; it may include long-term oral itraconazole and/or surgical resection. […] Voriconazole is the treatment of choice. Posaconazole is an alternative. Amphotericin may be used if initial treatment fails. […] Early administration of voriconazole or itraconazole. […] Surgical resection may be considered for cases unresponsive to medical therapy. […] For both primary skin infection and that associated with invasive aspergillosis, treatment has traditionally been with high-dose intravenous amphotericin. Voriconazole, itraconazole and caspofungin are other treatments that are used. […] Inhaled amphotericin may be used for patients with solid organ transplants when Aspergillus spp. are cultured from sputum but there is no evidence of pneumonia. […] Research into the development of vaccines against aspergillosis is ongoing.

• #7 Updated guidelines for the diagnosis and management of aspergillosis – Misch – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/11294/9775

  New guidelines for the diagnosis and treatment of infections due to Aspergillus species were published in August of 2016 by the Infectious Diseases Society of America (IDSA), replacing those previously published in 2008. These guidelines incorporate new data published between January 2008 and December 2014. The document provides guidance on non-culture-based diagnosis of Aspergillus infections, discourages the use of combination anti-fungal therapy for primary management, and begins to define the place in therapy for isavuconazole, a new anti-fungal drug of the azole class approved by the U.S. Food and Drug Administration (FDA) in March 2015 to treat aspergillosis and mucormycosis. […] A central recommendation that remains unchanged from the previous iteration of the guidelines is the pre-eminence of voriconazole as first-line therapy for treatment of all invasive forms of aspergillosis.

• #7 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend primary treatment with voriconazole (strong recommendation; high-quality evidence). […] Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence). […] Alternative therapies include liposomal AmB (strong recommendation; moderate-quality evidence), isavuconazole (strong recommendation; moderate-quality evidence), or other lipid formulations of AmB (weak recommendation; low-quality evidence). […] Combination antifungal therapy with voriconazole and an echinocandin may be considered in select patients with documented IPA (weak recommendation; moderate-quality evidence). […] Primary therapy with an echinocandin is not recommended (strong recommendation; moderate-quality evidence). Echinocandins (micafungin or caspofungin) can be used in settings in which azole and polyene antifungals are contraindicated (weak recommendation; moderate-quality evidence).

• #7 Aspergillus and Allergic Bronchopulmonary Aspergillosis | Cystic Fibrosis Foundation

  https://www.cff.org/managing-cf/aspergillus-and-allergic-bronchopulmonary-aspergillosis

  Treatment for ABPA involves prevention and treatment of acute episodes, or flare-ups. […] Treatment of ABPA has two parts. Inflammation in the lung is treated with corticosteroids. Fungal colonization is treated with antifungal medicines. […] Oral corticosteroid pills or liquid, such as prednisolone (brand names include Pediapred and Prelone), prednisone tablets, and methylprednisolone (brand names include Medrol) tablets, have anti-inflammatory effects. […] Antifungal medicines like itraconazole (brand names include Sporanox) reduce the amount of fungus in the lungs. […] Because steroids can have significant side effects and ABPA can be difficult to treat, CF providers may offer a therapy that targets one particular part of the immune system (so-called biologic therapies). One such therapy, omalizumab (Xolair), has been used to target IgE, which is often very elevated in patients with ABPA.

• #7 Aspergillosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/aspergillosis/

  Duration: Usually at least 6 months. […] Preferred agents: itraconazole or voriconazole (off-label). […] Voriconazole may be more effective in subacute invasive aspergillosis. […] Initiate antifungal treatment promptly. […] Preferred: voriconazole. […] Alternatives include: Liposomal amphotericin B, Isavuconazole.

• #7 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  All antifungal drugs can have serious side effects, including kidney and liver damage. Interactions between antifungal drugs and other medications are also common. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs. […] This procedure stops lung bleeding caused by an aspergilloma. A radiologist injects a material through a catheter that has been guided into an artery feeding a lung cavity where an aspergilloma is causing blood loss. The injected material hardens, blocking the blood supply to the area and stopping the bleeding. This treatment works temporarily, but the bleeding is likely to start again.

• #7 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Aspergillosis-Treatment.aspx

  Aspergilloma with single fungal mass often do not need any treatment if asymptomatic. Regular X-ray scans are done to observe the growth and the spread, if any. In case the patient starts exhibiting the symptoms including blood in sputum, antifungal medications are prescribed. […] Allergic forms of aspergillosis are usually treated with oral triazoles. Allergic bronchopulmonary aspergillosis (ABPA) patients are given corticosteroids (oral or nasal) during the acute episodes. Addition of a triazole drug to the treatment regimen reduces the dose requirement of corticosteroids. […] Aspergillus bronchitis is generally treated with antifungal medications in an effective manner. Triazoles and (1,3)-d-glucan synthase inhibitors are often administered in the patients with aspergillus sinusitis. However, membrane fungicides remain to be the treatments of choice for aspergillus sinusitis. Surgical intervention is also needed in many cases to locate and eliminate the fungus.

• #7 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #7

  https://link.springer.com/article/10.1007/s11046-023-00727-z

  Current investigations show encouraging results, so far mostly in preclinical settings. […] Therapeutic measures for IA currently consist of three antifungal drug classes, namely azoles (voriconazole, posaconazole, isavuconazole), polyenes [liposomal amphotericin-B (LAmB), amphotericin-B lipid complex (ABLC)] and echinocandins (caspofungin, anidulafungin, micafungin). […] The emergence of azole-resistance, drug-drug interactions, and toxicity, is often limiting current therapeutic approaches. […] The future looks brighter however, with a number of new antifungals in development. […] In this review we briefly discuss the current therapy standards of IA, primarily focusing on its pulmonary manifestation. […] In case of intolerance or refractory disease after 7 days of therapy with a first-line antifungal, a switch of drug class, meaning a switch from an azole to LAmB in most cases, is recommended.

• #7 Current Promising Therapeutic Targets for Aspergillosis Treatment – Journal of Pure and Applied Microbiology

  https://microbiologyjournal.org/current-promising-therapeutic-targets-for-aspergillosis-treatment/

  We have summarized 33 novel therapeutic targets present in Aspergillus genome which may further facilitate the antifungal drug discovery. […] Currently Broad-Spectrum Triazoles, Liposomal Amphotericin B, and Echinocandins are being used for Aspergillosis treatment, while increasing resistance against known antifungals is a major concern. […] There is an urgent need to discover novel of antifungal agents with optimum safety and efficacy. […] This review summarizes different drug targets in Aspergillus genomes and implications of their inhibition.

• #8 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend primary treatment with voriconazole (strong recommendation; high-quality evidence). […] Early initiation of antifungal therapy in patients with strongly suspected IPA is warranted while a diagnostic evaluation is conducted (strong recommendation; high-quality evidence). […] Alternative therapies include liposomal AmB (strong recommendation; moderate-quality evidence), isavuconazole (strong recommendation; moderate-quality evidence), or other lipid formulations of AmB (weak recommendation; low-quality evidence). […] Combination antifungal therapy with voriconazole and an echinocandin may be considered in select patients with documented IPA (weak recommendation; moderate-quality evidence). […] Primary therapy with an echinocandin is not recommended (strong recommendation; moderate-quality evidence). Echinocandins (micafungin or caspofungin) can be used in settings in which azole and polyene antifungals are contraindicated (weak recommendation; moderate-quality evidence).

• #8 Treatment of Aspergillosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6162797/

  Voriconazole, available in tablet, IV, and suspension formulation, is approved for the treatment of IA, Candida infections, scedosporiosis, and furasiosis. […] Isavuconazole, available in capsule and IV formulation, is another triazole preferred for the treatment of IA. […] A number of studies have suggested that posaconazole, available in delayed-release tablets, oral suspension, and IV formulation, may be an option to treat refractory IA. […] The echinocandins, which inhibit -1,3-glucan synthesis in the cell wall of fungi, have also been investigated for the treatment of IA. […] Current recommendations are summarized in Table 2. The Infectious Diseases Society of America (IDSA) 2016 guidelines recommend voriconazole as first-line treatment for IA (AI recommendation) with liposomal amphotericin B and isavuconazole as alternative options (AII recommendation). […] While currently available guidelines are targeted towards a small number of high-resource countries, they mostly fail to provide guidance for low- and middle-income countries (LMICs).

• #8 Aspergillosis: causes, types and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/aspergillosis-causes-types-and-treatment

  Aspergillosis: causes, types and treatment […] Aspergillus-related disease is rare, but results in high mortality rates. The limited treatment options and emerging antifungal drug resistance mean that accurate diagnosis and management is paramount. […] Aspergillus causes a broad range of diseases for which there are limited antifungal drug treatment options — a problem that is exacerbated by the emerging threat of antifungal drug resistance. As a result, there is a need for novel diagnostic and therapeutic approaches to improve patient outcomes. Pharmacists should be aware of the various side effects and drug interactions associated with the use of antifungal drugs in the treatment of Aspergillus-related disease. […] Treatment […] Voriconazole is recommended as first-line therapy for IPA, as it is associated with a lower mortality rate compared with amphotericin B. Isavuconazole is equally effective as voriconazole but less toxic. IPA should be treated with at least 12 weeks of antifungal therapy, although longer treatment courses may be required depending on clinical response and ongoing immunosuppression. Therapeutic drug monitoring is recommended during treatment with triazole antifungals. […] Long-term oral triazole therapy is the cornerstone of treatment for CPA. In cases of triazole intolerance or treatment failure, shorter courses of intravenous therapy with amphotericin B or an echinocandin may be used. Surgical management may be an option in CPA patients with localised disease. Many patients are deficient in gamma interferon (IFN) or interleukin 12 and benefit from gamma IFN supplementation. […] Short courses of systemic corticosteroids are used for exacerbations of ABPA, followed by long-term triazole therapy in many patients to reduce the fungal burden in those with frequent exacerbations or poorly controlled asthma. […] A four-month course of oral antifungal therapy is the mainstay of treatment for Aspergillus bronchitis. However, relapse is common (50%) and longer therapy may be required. […] Topical intranasal corticosteroids may help to treat AFRS and antifungals are only used in cases with relapsing disease. The treatment of aspergillosis varies depending on the specific disease.

• #8 Aspergillosis – Types, Causes, Symptoms, Diagnosis, Treatment and Prevention

  https://www.medindia.net/health/conditions/aspergillosis.htm

  Echinocandins: Caspofungin, Micafungin, and Anidulafungin. The echinocandins are a novel class of semisynthetic antifungals. Caspofungin is indicated in patients with probable or proven invasive aspergillosis. The recommended dosage of caspofungin in adults is a single 70-mg loading dose on day 1, followed by 50mg/day thereafter, administered by slow IV infusion of over a duration of 1 hour. […] Oral corticosteroids may be used in the treatment of allergic bronchopulmonary aspergillosis. […] Surgery may be used in the treatment of aspergillosis that causes bleeding in the lungs. A procedure called embolization may as be used, in which the bleeding artery is blocked to stop the bleeding.

• #8 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #9 IDSA Diagnosis and Management of Aspergillosis Guideline Summary

  https://www.guidelinecentral.com/guideline/21923/

  Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure. […] The IDSA recommends prophylaxis with posaconazole, voriconazole, micafungin during prolonged neutropenia for those who are at high risk for IA. […] Prophylaxis with caspofungin is also probably effective. […] Prophylaxis with itraconazole is effective, but therapy may be limited by absorption and tolerability. […] Triazoles should not be co-administered with other agents known to have potentially toxic levels with concurrent triazole co-administration (such as vinca alkaloids, and others).

• #10 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  We recommend antifungal prophylaxis with either a systemic triazole such as voriconazole or itraconazole or an inhaled AmB product for 3 to 4 months after lung transplant (strong recommendation; moderate-quality evidence). […] We suggest an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence). […] We recommend an individualized approach that takes into consideration the rapidity, severity, and extent of infection, patient comorbidities, and to exclude the emergence of a new pathogen (strong recommendation; low-quality evidence).

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