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CNS 5.2 Cerebral fungal infections – Aspergillus spp

Content version
U-119.2
Updated
10/20/2025 - 14:26

Recommendations

≥ 18 years

Indications: Cerebral aspergillosis with unknown azole susceptibility
Dosage Remarks
1st choice
voriconazole IV 4 mg/kg twice daily

+

amphotericin B liposomal (Ambisome) IV 5 mg/kg once daily

Voriconazole loading dose: day 1 6 mg/kg twice daily
2nd choice
amphotericin B liposomal (Ambisome) IV 5 mg/kg once daily
≥ 18 years

Indications: Cerebral aspergillosis with proven azole resistance
Dosage Remarks
amphotericin B liposomal (Ambisome) IV 5 mg/kg once daily
≥ 18 years

Indications: Cerebral aspergillosis with proven azole susceptibility
Dosage Remarks
1st choice
voriconazole IV 4 mg/kg twice daily

Voriconazole loading dose: day 1 6 mg/kg twice daily
≥ 18 years

Indications: Cerebral aspergillosis with proven azole susceptibility
Dosage Remarks
2nd choice
isavuconazole IV loading dose 200 mg, three times daily for 2 days

followed by

isavuconazole IV 200 mg once daily

Comments

For voriconazole therapeutic drug monitoring see "Other -> therapeutic drug monitoring"