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ASPERGILLOSIS TREATMENTS |
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The treatment method selected depends on
the form of aspergillosis. ABPA can usually be treated with many of
the same drugs used to treat asthma, such as systemic steroids.
Long-term therapy may be required, however, to prevent recurrence.
Antifungal agents are not recommended in the treatment of ABPA. In
cases of aspergilloma, it may become necessary to surgically remove
or reduce the size of a fungal mass, especially if the patient
continues to spit up blood. In aspergillosis cases affecting the
nose and nasal sinuses, surgery may also be required. In non-ABPA cases, the use of antifungal drugs may be indicated. In such cases, amphotericin B (Fungizone) is the first-line therapy. The prescribed dose will depend on the patient's condition but usually begins with a small test dose and then escalates. Less than one-third of patients are likely to respond to amphotericin B, and its side effects often limit its use. For patients who do not respond to oral amphotericin B, another option is a different formulation of the same drug called liposomal amphotericin B. For patients who fail to respond or who cannot tolerate amphotericin B, another drug called itraconazole (Sporanox), given 400-600 mg daily, has also been approved. Treatment generally lasts about 3 months. Giving itraconazole can produce adverse reactions if prescribed in combination with certain other drugs by increasing the concentrations of both drugs in the blood and creating a potentially life-threatening situation. Even antacids can significantly affect itraconazole levels. As a result, drug levels must be continually monitored to ensure that absorption is occurring at acceptable levels. Two other methods of treatment are being studied: direct instillation of an antifungal agent into the lungs and administration of antifungals using a nebulizer. Instilling or injecting amphotericin B or itraconazole directly into the lung cavity or into the fungal ball (aspergilloma) itself has been helpful in stopping episodes of hemoptysis, but not in preventing future recurrences. Furthermore, many patients with aspergillomas are poor risks for surgery because their lung function is already compromised. As a result, instillation of a fungal agent should only be considered in those who have significant hempotysis. A popular method of treating some respiratory disorders is to add a liquid drug to another carrier liquid and aerosolize or produce a fine mist that can be inhaled into the lungs through a device called a nebulizer. However, this has not yet been shown to improve the patient's condition in cases of aspergillosis, possibly because the drug is not reaching the aspergilloma. At this point, preventative therapy for aspergillosis is not suggested for susceptible individuals, primarily because overuse of the drugs used to fight fungal infections may lead to the development of drug-resistant aspergillosis against which current antifungal drugs are no longer effective. |
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| ASPERGILLOSIS RELATED ITEMS | ||
