Invasive aspergillosis
A life-threatening invasive fungal disease caused by Aspergillus fumigatus and less often A. flavus, A. niger, A. terreus. Occurs in patients with severe neutropenia, post organ or bone marrow transplantation, on long-term steroid therapy. Per IDSA 2024 and Spanish SEIMC 2023 first-line therapy includes voriconazole, isavuconazole, liposomal amphotericin B. Mortality 30–60%, reduced to 25% with early diagnosis via CT, galactomannan, and beta-D-glucan.
ICD-10 B44.04 drugs
Also known as: Invasive pulmonary aspergillosis, IPA
Drugs used for this condition
- AIsavuconazoleFirst line · Second-generation systemic triazole antifungalIsavuconazole is first-line antifungal for invasive aspergillosis and mucormycosis. IDSA 2024 places it on par with voriconazole, preferring isavuconazole in patients at QT risk (methadone, amiodarone) and in renal impairment (the IV formulation is cyclodextrin-free).
- APosaconazoleFirst line · Second-generation systemic triazole antifungalPosaconazole is first-line antifungal for invasive aspergillosis and mucormycosis in haematological cancer patients and after solid organ or haematopoietic stem cell transplantation. ESCMID and SEIMC 2022 recommend either posaconazole or voriconazole as first choice. Posaconazole shows lower hepatotoxicity and neurological adverse rates than voriconazole. Use requires blood-level monitoring (target ≥1 mcg/mL) and liver function checks.
- AVoriconazoleFirst line · Triazole derivatives, systemic antifungalsFirst-line for invasive aspergillosis per IDSA 2024 and Spanish SEIMC 2023 (Herbrecht NEJM 2002 showed superiority over amphotericin B). Adult dose: loading 6 mg/kg IV twice daily on day 1, then maintenance 4 mg/kg IV twice daily or 200 mg orally twice daily. Duration – minimum 6–12 weeks depending on clinical response and immune status. Target trough concentration (TDM) 1–5.5 mcg/mL. Alternatives – isavuconazole, liposomal amphotericin B.
- BItraconazoleSecond line · Antifungal, triazoleTriazole for long-term maintenance therapy of invasive aspergillosis after successful induction with voriconazole or isavuconazole. SEIMC and ESCMID position itraconazole as second-line.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit