Invasive Pulmonary Aspergillosis Treatment Guidelines

Primary Treatment Recommendations

The Infectious Diseases Society of America recommends voriconazole as the first-line treatment for invasive pulmonary aspergillosis, with superior efficacy and survival compared to amphotericin B formulations 1, 2
Voriconazole has a loading dose of 6 mg/kg IV every 12 hours for the first 24 hours, followed by a maintenance dose of 4 mg/kg IV every 12 hours for a minimum of 7 days 1
The American College of Clinical Pharmacy suggests that liposomal amphotericin B (L-AMB) can be used as an alternative first-line option for patients with voriconazole contraindications or intolerance, at a dose of 3-5 mg/kg/day IV 1, 2

The treatment duration for invasive pulmonary aspergillosis is typically 6-12 weeks, and therapy should be continued throughout the immunosuppression period and until complete resolution or stabilization of clinical and radiographic findings 1, 2, 5
Therapeutic drug monitoring (TDM) is mandatory for voriconazole due to variable pharmacokinetics and a narrow therapeutic window, with target trough levels ensuring adequate serum concentrations 3, 4, 5

Liposomal amphotericin B formulations can be used as salvage therapy at a dose of 3-5 mg/kg/day IV 1, 5
Caspofungin can be used as salvage therapy at a loading dose of 70 mg on day 1, followed by 50 mg/day IV 1, 5

Voriconazole dosing for pediatric patients (≥2 years, not neonates) is 5-7 mg/kg IV every 12 hours 1, 4
Neonates should be treated with liposomal amphotericin B as the first choice 4

Surgical resection should be considered for localized disease, especially if refractory to medical therapy 1