Treatment of cerebral Aspergillosis with itraconazole: do high doses improve the prognosis?
We describe a 72-year-old woman with chronic asthma who presented with cerebral abscesses due to Aspergillus fumigatus after she received treatment with corticosteroids. Therapy with high-dose itraconazole (800 mg/d for 5 months, followed by 400 mg/d for an additional 4.5 months) resulted in complete resolution of all lesions. Serum concentrations of the drug ranged from 2 micrograms/mL to 30 micrograms/mL. Review of 20 cases of cerebral aspergillosis that were treated with itraconazole revealed that three of the four patients who received high doses (800 mg/d in the adults) of the drug responded favorably, while only two of the 16 patients who received a dose of 400 mg/d were cured. The use of high-dose itraconazole appears to be justified for high-risk patients with cerebral aspergillosis for whom conventional therapy has failed.
Sánchez
C
C
Department of Internal Medicine and Infectious Diseases, University of Barcelona, Terrassa, Spain.
Mauri
E
E
Dalmau
D
D
Quintana
S
S
Aparicio
A
A
Garau
J
J
D000368:Aged; D000935:Antifungal Agents / Q000378:metabolism / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000473:pathology; D001232:Aspergillus fumigatus / Q000187:drug effects / Q000302:isolation & purification; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017964:Itraconazole / Q000378:metabolism / Q000627:therapeutic use*; D011379:Prognosis; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D017964:Itraconazole