Recommendations for managing Aspergillus osteomyelitis and joint infections based on a review of the literature.
OBJECTIVE
To produce recommendations for the management of Aspergillus osteomyelitis and joint infections.


METHODS
Published literature was surveyed to identify both case reports of Aspergillus osteomyelitis and joint infections and anti-fungal pharmacology of anti-fungal agents. Included in the pharmacological review was an assessment of new and investigational anti-fungals to consider their potential role in the management of this infection.


RESULTS
Successful treatments, identified from the cases reviewed, were based on combination anti-fungal therapy with one agent having good bone penetration and one having reliable anti-Aspergillus activity.


CONCLUSIONS
For the management of serious Aspergillus osteomyleitis/joint infections amphotericin B in combination with flucytosine is recommended. A number of second line treatment combinations are identified. Monotherapy is appropriate with an azole in clinically stable patients.
Kirby
Andrew
A
Department of Microbiology, Clinical Sciences Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. kirbyandrew@doctors.org.uk
Hassan
Ibrahim
I
Burnie
James
J
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D001228:Aspergillosis / Q000188:drug therapy* / Q000601:surgery; D001230:Aspergillus / Q000187:drug effects*; D019468:Disease Management; D025141:Drug Resistance, Fungal; D004359:Drug Therapy, Combination; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D017211:Treatment Failure
D000935:Antifungal Agents; D000666:Amphotericin B; D005437:Flucytosine