Treating invasive aspergillosis.

Salvage therapies in patients with invasive aspergillosis have little efficacy, so it is imperative to choose an effective initial therapy, a study led by Thomas F. Patterson, M.D., of the University of Texas, suggests.

Of 144 patients treated initially with voriconazole, 36% were switched to another licensed antifungal therapy before completion of the initial therapy, and 48% of those responded. Of 133 patients initially treated with amphotericin B, 80% were switched to another antifungal, and 38% of those responded. Switches were made because of intolerance or insufficient response in 24% of voriconazole patients, compared with 70% of amphotericin B patients (Clin. Infect. Dis. 2005;41:1448-52).

Salvage therapy response rates were poorest with lipid formulations of amphotericin B, particularly when they were used after failed amphotericin B therapy. The overall response rate to such formulations was 30%, but the response rate in those who switched due to poor response to amphotericin B was 12%.

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