Isavuconazole Recommendations and Treatment Duration for Invasive Fungal Infections

Invasive Pulmonary Aspergillosis

The Infectious Diseases Society of America (IDSA) recommends isavuconazole as an alternative primary therapy to voriconazole for invasive pulmonary aspergillosis, based on the SECURE trial that demonstrated non‑inferiority to voriconazole with fewer drug‑related adverse effects (moderate‑quality evidence). 1
The 2023 Taiwan COVID‑19 clinical guideline advises that single‑agent or sequential monotherapy with voriconazole, isavuconazole, posaconazole, or liposomal amphotericin B is acceptable for COVID‑19‑associated pulmonary aspergillosis (expert consensus). 2

The 2019 global mucormycosis guideline (Lancet Infectious Diseases) recommends isavuconazole as an alternative first‑line therapy to liposomal amphotericin B, especially in patients with pre‑existing renal impairment (moderate recommendation). 3
The same guideline specifies a dosing regimen of 200 mg isavuconazole (equivalent to 372 mg isavuconazonium) – three doses on days 1‑2, then once daily from day 3 as a moderately recommended option when amphotericin B formulations are contraindicated or not tolerated (moderate recommendation). 3

For invasive aspergillosis, a minimum treatment duration of 6–12 weeks is advised, with the exact length depending on the degree and duration of immunosuppression, disease site, and evidence of clinical improvement (moderate evidence). 1
For invasive mucormycosis, therapy generally extends for several months, reflecting the need for prolonged exposure to achieve cure (moderate evidence). 3
Secondary prophylaxis with isavuconazole should be initiated in patients who have successfully completed treatment for invasive aspergillosis and who will undergo subsequent immunosuppressive therapy (moderate evidence). 1