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Management of chronic pulmonary aspergillosis
Author(s) -
Izumikawa Koichi,
Tashiro Masato,
Kohno Shigeru
Publication year - 2012
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2012.06758.x
Subject(s) - azole , intensive care medicine , medicine , pulmonary aspergillosis , aspergillus fumigatus , aspergillosis , echinocandins , antifungal , amphotericin b , dermatology , immunology , caspofungin
Chronic pulmonary aspergillosis (CPA) is a relatively rare, slowly progressive pulmonary syndrome caused by Aspergillus spp. The scarcity of clinical evidence for its management is an important issue. Oral azoles are recommended as the primary treatment of CPA; however, the evidence for their effectiveness is insufficient. Azole‐resistant A. fumigatus is rapidly increasing and becoming a serious concern. Because long‐term administration of azoles is the mainstay of CPA, azole resistance may pose a serious threat. Furthermore, prolonged oral administration of azoles may lead to increased azole resistance in CPA patients. Therefore, alternative management strategies for CPA must be considered, and one option may involve the use of intravenous antifungals such as echinocandins and polyens. The utility of these antifungals, however, has not been well evaluated and remains controversial because the drugs are expensive and require patients to be admitted to the hospital for their use. New antifungal drugs with novel mechanisms of action are also needed.