Antifungal agents for the treatment of pulmonary aspergillosis
| Antifungal class | Drugs | Dosage | Therapeutic use | Comments |
| Polyenes | Deoxycholate amphotericin B | 1–1.5 mg·kg−1 once daily (intravenous only) | Should be avoided (privilege lipid formulations of amphotericin B if available) | Monitor kidney function and electrolytes (K+) Consider co-administration of paracetamol if fever and/or rigors Consider alternative therapy for Aspergillus terreus |
| Liposomal amphotericin B | 3–5 mg·kg−1 once daily (intravenous only) | Treatment of IPA (second choice after triazoles; first choice in areas with high prevalence of azole-resistant Aspergillus fumigatus isolates if no culture/fungigram available) | ||
| Amphotericin B lipid complex | 5 mg·kg−1 once daily (intravenous only) | Treatment of IPA (privilege liposomal amphotericin B if available) | ||
| Amphotericin B colloidal dispersion | 6 mg·kg−1 once daily (intravenous only) | Treatment of IPA (privilege liposomal amphotericin B if available) | ||
| Triazoles | Itraconazole | 200 mg once daily or twice daily (intravenous or oral) TDM recommended (target: Ctrough: 1–4 mg·L−1) | Treatment of CPA | Monitor hepatic tests (ALT, AST, ALP, GGT, bilirubin) Monitor ECG (QT interval, in particular voriconazole) DDIs (in particular voriconazole) Consider alternative therapy for Aspergillus calidoustus or cryptic species of section Fumigati (e.g. Aspergillus lentulus) |
| Voriconazole | Intravenous: 6 mg·kg−1 twice daily (D1), then 4 mg·kg−1 twice daily Oral: 400 mg twice daily (D1), then 200–300 mg twice daily TDM recommended (target: Ctrough: 1–5 mg·L−1) | Treatment of IPA (first choice) Treatment of CPA | ||
| Posaconazole | Intravenous or oral tablets: 300 mg twice daily (D1), then 300 mg once daily Oral suspension: 200 mg three times daily TDM recommended (target: Ctrough: >1 mg·L−1 for therapy and >0.7 mg·L−1 for prophylaxis) | Prophylaxis or treatment of IPA Treatment of CPA (privilege itraconazole or voriconazole) Oral suspension should be avoided or limited to prophylaxis (privilege intravenous formulation or oral tablets) | ||
| Isavuconazole | 200 mg three times daily (D1–2), then 200 mg once daily TDM not routinely recommended (may be considered) | Treatment of IPA Treatment of CPA (privilege itraconazole or voriconazole) | ||
| Echinocandins | Caspofungin | 70 mg (D1), then 50 mg once daily (intravenous only) | Treatment of IPA as monotherapy (third choice after triazoles and lipid formulations of amphotericin B) Treatment of IPA in combination with triazoles (severe cases and/or positive GM; azole-resistant Aspergillus fumigatus isolates) | |
| Anidulafungin | 200 mg (D1), then 100 mg once daily (intravenous only) | |||
| Micafungin | 100 mg once daily (intravenous only) |
ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CPA: chronic pulmonary aspergillosis; D1: day 1; DDI: drug–drug interaction; GGT: gamma glutamyltranspeptidase; GM: galactomannan; IPA: invasive pulmonary aspergillosis; TDM: therapeutic drug monitoring, W1: week 1.