Document 0264
 DOCN  M94A0264
 TI    Treatment of invasive aspergillosis.
 DT    9412
 AU    Denning DW; Department of Infectious Diseases and Tropical Medicine
       (Monsall; Unit), North Manchester General Hospital, Crumpsall.
 SO    J Infect. 1994 May;28 Suppl 1:25-33. Unique Identifier : AIDSLINE
       MED/94358454
 AB    Invasive aspergillosis is generally a life-threatening invasive
       opportunistic mycosis affecting principally the upper and lower
       respiratory tract. Therapeutic response rates vary considerably from one
       host group to another with particularly high mortality rates in bone
       marrow transplant, liver transplant and patients with aplastic anaemia
       or AIDS. Only two drugs are useful for therapy, amphotericin and
       itraconazole. Recent advances in the formulation of amphoterin B
       (AmBisome and Amphocil) have resulted in intravenous preparations with
       lower toxicity, particularly nephrotoxicity, but it has yet to be shown
       that they have an increased therapeutic index for the treatment of
       invasive aspergillosis. Itraconazole can only be used orally and in some
       particularly high-risk or critically ill patients adequate serum
       concentrations cannot be achieved. The addition of flucytosine or
       rifampicin to amphotericin B therapy has, at best, only a marginal
       benefit. Surgery is essential for some manifestations of invasive
       aspergillosis. This article reviews therapeutic strategies including
       criteria for initiation of therapy, combination and sequential therapy,
       duration of therapy and secondary prophylaxis and indications for
       surgery in invasive aspergillosis.
 DE    Amphotericin B/ANALOGS & DERIVATIVES/*THERAPEUTIC USE
       Aspergillosis/*DRUG THERAPY/SURGERY  AIDS-Related Opportunistic
       Infections/DRUG THERAPY  Cholesterol Esters/THERAPEUTIC USE  Drug
       Carriers  Drug Therapy, Combination  Flucytosine/THERAPEUTIC USE  Human
       Immunocompromised Host  Infusions, Intravenous
       Itraconazole/*THERAPEUTIC USE  Liposomes  Opportunistic Infections/DRUG
       THERAPY  Rifampin/THERAPEUTIC USE  JOURNAL ARTICLE  REVIEW  REVIEW,
       TUTORIAL

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