Treatment of Invasive Pulmonary Aspergillosis Due to Azole-Resistant Aspergillus fumigatus
Invasive pulmonary aspergillosis (IPA) caused by azole-resistant Aspergillus fumigatus presents a distinct clinical challenge. Resistance to azole antifungals removes the standard first-line option, requiring a different therapeutic strategy.
Clinical Scenario
Confirmed or suspected IPA where the causative organism is Aspergillus fumigatus with demonstrated or suspected azole resistance. Standard azole-based therapy is not appropriate in this setting, and an alternative approach is required from the outset.
Treatment Approach — Partial Overview
Management requires a non-azole antifungal strategy. A specific polyene antifungal is established as the first-line agent for this scenario. A combination-based alternative also exists, though its clinical efficacy in azole-resistant IPA has not been fully demonstrated. Complete regimen details — dosing, sequencing, and the full range of alternatives — are available in the structured protocol.
References
DOI: 10.1183/16000617.0114-2022
- Liposomal amphotericin B is a second-line therapy of IPA and the first-line therapy for azole-resistant IPA.
- This combination also represents a therapeutic option for the treatment of azole-resistant IPA (as an alternative to liposomal amphotericin B), but clinical efficacy in this setting is not demonstrated.