Aspergillosis itraconazole

For the treatment of blastomycosis, histoplasmosis, and aspergillosis, itraconazole can be given as oral capsules or IV. The safety and efficacy of the injection administered for more than 14 days are not known. 

Invasive aspergillosis For the treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (ie, amphotericin B, lipid formulations of amphotericin B, itraconazole). Caspofungin has not been studied as initial therapy for invasive aspergillosis. 

Itraconazole has replaced ketoconazole as the drug of choice in the treatment of paracoccidioidomycosis and chromomycosis, based on its lower toxicity profile. Efficacy has also been reported in the treatment of invasive aspergillosis. 

Blastomycosis, histoplasmosis, sporotrichosis, paracoccidioidomycosis, and chromomycosis are better treated with itraconazole than ketoconazole, although ketoconazole remains an alternative agent. Ketoconazole is ineffective in the treatment of cryptococcosis, aspergillosis, and mucormycosis. Candidemia is best treated with fluconazole or amphotericin B. 

Voriconazole is similar to itraconazole in its spectrum of action, having excellent activity against Candida sp (including fluconazole-resistant species such as C krusei) and the dimorphic fungi. Voriconazole is less toxic than amphotericin and is the treatment of choice for invasive aspergillosis. 

Type of Infection Aspergillosis Principal Sites of Infection Lungs, other organs, body orifices Principal Agent(s) Amphotericin B Secondary/Alternative Agent(s) Itraconazole, voriconazole... 

Itraconazole [it ra KON a zole] is a recent addition to the azole family of antifungal agents. Like fluconazole it is a synthetic triazole, and it also lacks the endocrinologic side effects of ketoconazole. Its mode of action is the same as that of the other azoles. Itraconazole is now the drug of choice for the treatment of blastomycosis. Unlike ketoconazole, it is effective in AIDS-associated histoplasmosis. However, current studies show that it may also be effective in the treatment of aspergillosis, candidemia, coccidioidomycosis, and cryptococcosis. Thus it has a broad antifungal spectrum. 

Schaffner A, Bohler A. Amphotericin B refractory aspergillosis after itraconazole evidence for significant antagonism. Mycoses 1993 36(11-12) 421. ... 

In three patients with pulmonary MAC and aspergillosis infections, itraconazole was suggested to increase the plasma concentration of clarithromycin as well as the... 

The in vitro effects of the combination of amphotericin with itraconazole was tested using six strains of A. fumi-gatus, and an antagonistic effect was found after pretreatment for all strains in vitro and for one strain in a mouse model of aspergillosis (56). 

CaiUot D, Bassaris H, McGeer A, Arthur C, Prentice HG, Seifert W, De Beule K. Intravenous itraconazole followed by oral itraconazole in the treatment of invasive pulmonary aspergillosis in patients with hematologic mahgnancies, chronic granulomatous disease, or AIDS. Qin Infect Dis 2001 33(8) e83-90. 

Denning DW, Van Wye JE, Lewiston NJ, Stevens DA. Adjunctive therapy of allergic bronchopulmonary aspergillosis with itraconazole. Chest 1991 100(3) 813-19. 

Parmar JS, Howell T, Kelly J, BUton D. Profound adrenal suppression secondary to treatment with low dose inhaled steroids and itraconazole in allergic bronchopulmonary aspergillosis in cystic fibrosis. Thorax 2002 57(8) 749-50. 

Posaconazole is similar in structure to itraconazole. It was well tolerated and as effective as fluconazole 100 mg in two large randomized comparisons in HIV-infected patients with oropharyngeal candidiasis. In a salvage study in patients with a variety of invasive fungal infections, there were response rates of 44-80% in patients with aspergillosis, fusariosis, cryptococcosis, candidiasis, and pheohyphomycoses after 4-8 weeks of therapy (1,2). 

Jennings TS, Hardin TC. Treatment of aspergillosis with itraconazole. Ann Pharmacother 1993 27 1206-1211. 

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