MYC 2.1 Aspergillus

Recommendations

≥ 18 years

Indications: Invasive aspergillosis with unknown azole resistance
	Dosage	Remarks
1st choice	voriconazole IV 4 mg/kg twice daily + anidulafungin IV loading dose 200 mg, 100 mg once daily	Voriconazole should be loaded first: day 1 6 mg/kg twice daily Alternatives to anidulafungin are caspofungin (70 mg loading, 50 mg once daily IV) or micafungin (100 mg once daily IV).

≥ 18 years

Indications: Invasive aspergillosis with unknown azole resistance
	Dosage	Remarks
2nd choice	voriconazole IV 4 mg/kg twice daily + liposomal amphotericin B (Ambisome) IV 3 mg/kg once daily	Voriconazole should be loaded first: day 1 6 mg/kg twice daily For (possible) mixed azole-susceptible/resistant strains or (possible) co-infection with Mucorales

≥ 18 years

Indications: Invasive aspergillosis with unknown azole resistance
	Dosage	Remarks
3rd choice	liposomal amphotericin B (Ambisome) IV 3 mg/kg once daily	if contraindication to azole therapy

≥ 18 years

Indications: Invasive aspergillosis with demonstrated azole susceptibility
	Dosage	Remarks
1st choice	voriconazole IV 4 mg/kg twice daily	Voriconazole should be loaded first: day 1 6 mg/kg twice daily

≥ 18 years

Indications: Invasive aspergillosis with demonstrated azole resistance
	Dosage	Remarks
1st choice	liposomal amphotericin B (Ambisome) IV 3 mg/kg once daily

≥ 18 years

Indications: Invasive aspergillosis with demonstrated azole resistance
	Dosage	Remarks
2nd choice	posaconazole IV 300 mg once daily	If proven susceptible
2nd choice alternative	anidulafungin IV loading dose 200 mg, 100 mg once daily or caspofungin IV loading dose 70 mg, 50 mg once daily or micafungin IV 100 mg once daily

≥ 18 years

Indications: Secondary prophylaxis in primary immunodeficiency (e.g. CGD) or after HSCT
	Dosage	Remarks
	voriconazole PO 200 mg twice daily or posaconazole PO 300 mg once daily	posaconazole tablets

≥ 18 years

Indications: Chronic pulmonary aspergillosis
	Dosage	Remarks
	voriconazole PO 200 mg twice daily or posaconazole PO 300 mg once daily or itraconazole PO 200 mg twice daily or isavuconazole PO 200 mg once daily

≥ 18 years

Indications: Aspergilloma
	Dosage	Remarks
		Surgical resection. Peri-operative prophylaxis: voriconazole 200 mg PO twice daily from 2 days before to 3 days after the procedure. In inoperable patients consider arterial embolisation and/or intralesional conventional amphotericin B

Comments

In case of intolerance or adverse effects of voriconazole: substitute with isavuconazole IV 200 mg three times daily for 2 days followed by isavuconazole IV 200 mg once daily

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

See Q-portal for document influenza-associated aspergillosis

≥ 18 years

≥ 18 years

≥ 18 years

≥ 18 years

≥ 18 years

≥ 18 years

≥ 18 years

≥ 18 years

≥ 18 years