An overview of the available treatments for chronic cavitary pulmonary aspergillosis.
Expert Rev Respir Med. 2020 Apr 05;:
Authors: Sehgal IS, Dhooria S, Muthu V, Prasad KT, Agarwal R
Introduction: Chronic pulmonary aspergillosis (CPA) is a chronic infection of the lung parenchyma caused by Aspergillus fumigatus complicating structural lung diseases. Of the different types of CPA, chronic cavitary pulmonary aspergillosis (CCPA) is the most common form. Untreated, most patients with CCPA will progress to chronic fibrosing pulmonary aspergillosis. The mainstay of treatment of CCPA is oral triazoles. However, many gaps exist in clinical decision-making about the agent of choice, the duration, and the assessment of treatment response.Areas covered: In this review, we discuss the approach to diagnosis and treatment of CCPA. We have searched the PubMed and EmBase databases (from inception till 31st October 2019) to identify studies describing the use of anti-fungal agents in CCPA.Expert opinion: In our opinion, treatment for CCPA should be initiated with oral itraconazole for at least six months. In case of poor response or intolerance to itraconazole, voriconazole should be considered. Intravenous agents, including amphotericin B and echinocandins, may be used in those with either treatment failure or those who do not tolerate oral antifungal agents. Posaconazole and isavuconazole may be used as salvage therapy due to a better pharmacokinetic/pharmacodynamic profile of the former and reduced drug-drug interactions with the latter.
PMID: 32249630 [PubMed – as supplied by publisher]