[Therapy of invasive aspergillosis with itraconazole: our own experiences and review of the literature]

Abstract

Invasive aspergillosis is one of the most threatening infections in immunocompromised patients of risk. The classical standard therapy of deep-seated mycoses--amphotericin B as monotherapy or in combination with 5-fluorocytosine--shows a response rate in aspergillosis of 55-60%. The new triazole compound itraconazole demonstrating a high in vitro activity against Aspergillus species was used in the recent years in several studies in the treatment of invasive aspergillosis. We report on our own experiences of itraconazole therapy in invasive aspergillosis with 20 patients suffering from well-known classical underlying diseases and factors of risk. Diagnosis was based on clinical symptomatology and was serologically and culturally proved. Special efforts were made for an early diagnosis according to clinical criteria. Therefore, in numerous cases clinical diagnosis was made several days prior to mycological confirmation, and antimycotic therapy could be started. The mean dosis administered was 400 mg itraconazole per day. With four patients no therapy response could be observed. In one patient a partial remission was obtained. In 15 patients aspergillosis was cured. In our patients the rate of complete remission, therefore, amounted to 75%. In evaluating 12 published studies on itraconazole therapy of invasive aspergillosis (including our own patients) a response rate of 63% (169 of 269 patients) could be calculated. Therefore, increasing experience is indicating that itraconazole therapy might be an alternative to classical amphotericin B therapy of invasive aspergillosis.