Treatment of Proven or Probable Invasive Pulmonary Aspergillosis When Standard Antifungals Cannot Be Used
In patients with proven or probable invasive pulmonary aspergillosis, preferred antifungal agents are well established. However, certain underlying conditions or drug tolerability issues may prevent their use — and a specific third-line intravenous alternative is available for these cases.
Clinical Scenario
Confirmed or highly suspected invasive pulmonary aspergillosis (proven or probable) in a patient where triazoles — which are the privileged treatment for proven or probable IPA — or amphotericin B formulations cannot be administered due to underlying conditions or toxicity concerns.
Treatment Approach (Partial)
When triazoles and amphotericin B formulations are not appropriate, intravenous echinocandin monotherapy may be considered as a third-choice option. The complete agent selection, sequencing, and clinical decision algorithm are available in the full protocol.
References
DOI: 10.1183/16000617.0114-2022
- Triazoles (voriconazole, isavuconazole or posaconazole) should be privileged for proven or probable IPA and liposomal amphotericin B for possible IPA to ensure broad coverage including the Mucorales and azole-resistant Aspergillus species.
- Currently, echinocandins are not routinely recommended for IPA treatment, except in particular situations when underlying conditions or toxicity prevents the use of triazoles or amphotericin B formulations.
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