Treatment of drug-resistant Aspergillus infection

Abstract

Triazole antifungals are frontline drugs for the treatment and prophylaxis of infections due to Aspergillus species. Azole resistance is an emerging problem and is associated with treatment failure in several case series. The management of azole-resistant invasive aspergillosis remains a challenge and there are no guidelines with appropriate recommendations. The current clinical practice suggests that liposomal amphotericin B or a combination of voriconazole or posaconazole with an echinocandin may be effective. Although cross-resistance within the azoles seems to be common, the role of azoles in the management of azole-resistant aspergillosis remains unclear, but optimizing drug exposure is critical for treatment success.

Keywords:

• antifungal treatment
• aspergillosis
• Aspergillus
• azole resistance
• posaconazole
• voriconazole

Declaration of interests

C Lass-Flörl has received grant support from the Astellas Pharma, Gilead Sciences, Pfizer, Schering Plough and Merck Sharp & Dohme. She has been an advisor/consultant to Gilead Sciences, Merck Sharp & Dohme, Pfizer, Basilea Pharmaceutica and Schering Plough. She has received travel/accommodation expenses and has been paid for talks on behalf of Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas and Schering Plough. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.