Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin - review of the lite
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April 28, 2011 Eur J Med Res (2011) 16: 145-152
145 © I. Holzapfel Publishers 2011
PRoPHylAxIs And TREATMEnT oF InvAsIvE AsPERgIllosIs wITH voRIconAzolE, PosAconAzolE And cAsPoFungIn – REvIEw oF THE lITERATuRE M. Karthaus Klinikum neuperlach, München, germany
Abstract Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. Although mortality of invasive aspergillosis remains as high as 30-50%. Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. Randomized trials have been undertaken for the prophylaxis as well as treatment of invasive aspergillosis in the last two decades. Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome or patients with graft versus host disease after allogeneic transplantation. Efficacy has been shown for first-line therapy of invasive aspergillosis with voriconazole and liposomal amphotericin B. gastrointestinal resorption for the azoles posaconazole, voriconazole and itraconazole differ considerably. while oral voriconazole resportion is reduced when taken with food, posaconazole has to be taken with fatty food for optimal intestinal resorption. Beside all advances in the management of invasive aspergillosis important questions remain unresolved. This article reviews the current state of prophylaxis and treatment of invasive aspergillosis and points out clinicians unmet needs.
of infection related death. Invasive aspergillus infections are rarely observed in healthy hosts [2, 3]. Therefore a thorough knowledge of risk factors, potential causative organisms, and the safety and efficacy of appropriate antifungal agents is required for optimal management. Risk factors for aspergillus infections are outlined in Table 1 [4, 5]. Infections due to Aspergillus species are caused in most cases by Aspergillus fumigatus, far ahead of Aspergillus flavus, Aspergillus niger, Aspergillus terreus and other Aspergillus species (Table 2). species distribution may differ which means that local epidemiology should be
InTRoducTIon Fungal infections are an important cause of morbidity for patients with hematological malignancies. The epidemiology of invasive fungal infections has changed within the last decade. while infections due to candida species continue to be frequent despite a broader use of azoles in the prophylactic setting, infections due to Aspergillus species remain the leading pathogen in the postmortem epidemiology [1]. The genus Aspergillus includes over 185 species. out of these around 20 have been reported causative of opportunistic infections in man. The manifestation and severity of the aspergillosis disease depends upon the immune status of the patient. Invasive aspergillus infections most commonly affect the lung (see Fig. 1) and sinuses. other forms of the disease are central nervous aspergillosis, osteomyelitis, endophthalmi
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