Fungal Lung Infection Treatment

Treatment by Infection Type

The American College of Physicians recommends voriconazol as the first-line treatment for invasive aspergillosis, with a loading dose of 6 mg/kg IV every 12 hours on the first day, followed by 4 mg/kg IV every 12 hours or 200 mg oral twice a day, due to its superior efficacy and better survival rates (71% vs 58% at 12 weeks) compared to amphotericin B 1, 2
The Infectious Diseases Society of America suggests anfotericina B liposomal (L-AmB) at a dose of 3-5 mg/kg/day IV as an alternative for patients who cannot tolerate voriconazol 1, 2
Isavuconazol is another alternative with comparable efficacy to voriconazol 2
The European Society of Clinical Microbiology and Infectious Diseases recommends itraconazol or voriconazol orally as the treatment of choice for chronic pulmonary aspergillosis 3, 4, 5
The American Thoracic Society recommends anfotericina B liposomal at a dose of ≥5 mg/kg/day as the preferred treatment for mucormycosis (zygomycosis) 6
The Centers for Disease Control and Prevention recommends trimetoprim/sulfametoxazol (TMP/SMX) at a dose of TMP 15-20 mg/kg plus SMX 75-100 mg/kg daily for Pneumocystis jirovecii (PCP) 6

The International Society for Antimicrobial Chemotherapy recommends serial clinical evaluation of symptoms and signs, regular radiographic images with CT, and serial galactomannan serum tests to monitor response to treatment in aspergillosis 2, 7
The European Society of Clinical Microbiology and Infectious Diseases suggests monitoring therapeutic levels for azole antifungals, especially in cases of treatment failure 1
The Infectious Diseases Society of America recommends liposomal formulations of amphotericin B for patients who fail primary therapy 1
The American College of Physicians suggests echinocandins (caspofungin, micafungina) as rescue therapy options 1, 7

The American Thoracic Society notes that Aspergillus terreus is clinically resistant to amphotericin B, requiring therapy with azoles 1
The European Society of Clinical Microbiology and Infectious Diseases warns that delayed antifungal therapy while waiting for diagnostic confirmation can worsen outcomes in high-risk patients 2
The Infectious Diseases Society of America does not recommend the use of echinocandins as primary monotherapy due to their inferior efficacy compared to voriconazol 2
The American College of Physicians notes that combination therapy is not routinely recommended for primary treatment but may be considered for rescue therapy 1
The European Society of Clinical Microbiology and Infectious Diseases suggests that in areas with high prevalence of A. fumigatus resistant to azoles, liposomal amphotericin B may replace voriconazol as first-line treatment 2

The standard treatment duration for invasive pulmonary aspergillosis is 6-12 weeks, and treatment should continue until all clinical and radiological findings have resolved or stabilized, according to the Infectious Diseases Society of America 8, 9
The recommended treatment duration for COVID-19-associated pulmonary aspergillosis (CAPA) is 6-12 weeks, as suggested by the Infectious Diseases Society of America 8

The loading dose is 6 mg/kg IV every 12 hours for the first 24 hours, as recommended by the Infectious Diseases Society of America 10
The maintenance dose is 4 mg/kg IV every 12 hours for at least 7 days, according to the Infectious Diseases Society of America 10
Oral treatment can be switched to 200 mg every 12 hours (orally), as suggested by the Infectious Diseases Society of America 10

Surgical resection should be considered for localized disease, especially if it is resistant to medical treatment, as recommended by the Infectious Diseases Society of America 9
Surgical intervention may be necessary for pulmonary lesions close to major vessels or the pericardium, according to the Infectious Diseases Society of America 9
Chest wall invasion, empyema, and single cavitory lesion with persistent tracheobronchial hemoptysis should be evaluated for surgical intervention, as suggested by the Infectious Diseases Society of America 9

Voriconazole has significant CYP450 interactions and requires careful drug review, especially with immunosuppressants, anticonvulsants, and other azoles, as recommended by the Infectious Diseases Society of America 9, 10