Verweij, Paul E., Ananda-Rajah, Michelle ORCID: 0000-0001-7164-3108, Andes, David ORCID: 0000-0002-7927-9950, Arendrup, Maiken C., Bruggemann, Roger J., Chowdhary, Anuradha ORCID: 0000-0002-2028-7462, Cornely, Oliver A., Denning, David W., Groll, Andreas H., Izumikawa, Koichi, Kullberg, Bart Jan, Lagrou, Katrien, Maertens, Johan, Meis, Jacques F., Newton, Pippa, Page, Iain, Seyedmousavi, Seyedmojtaba ORCID: 0000-0002-6194-7447, Sheppard, Donald C., Viscoli, Claudio, Warris, Adilia ORCID: 0000-0001-6586-3358 and Donnelly, J. Peter (2015). International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus. Drug Resist. Update, 21-22. S. 30 - 41. EDINBURGH: CHURCHILL LIVINGSTONE. ISSN 1532-2084

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Abstract

An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome (R)). In regions with environmental resistance rates of >= 10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class. (C) 2015 The Authors. Published by Elsevier Ltd.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Verweij, Paul E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ananda-Rajah, MichelleUNSPECIFIEDorcid.org/0000-0001-7164-3108UNSPECIFIED
Andes, DavidUNSPECIFIEDorcid.org/0000-0002-7927-9950UNSPECIFIED
Arendrup, Maiken C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruggemann, Roger J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chowdhary, AnuradhaUNSPECIFIEDorcid.org/0000-0002-2028-7462UNSPECIFIED
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Denning, David W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Groll, Andreas H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Izumikawa, KoichiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kullberg, Bart JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lagrou, KatrienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maertens, JohanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meis, Jacques F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Newton, PippaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Page, IainUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seyedmousavi, SeyedmojtabaUNSPECIFIEDorcid.org/0000-0002-6194-7447UNSPECIFIED
Sheppard, Donald C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Viscoli, ClaudioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Warris, AdiliaUNSPECIFIEDorcid.org/0000-0001-6586-3358UNSPECIFIED
Donnelly, J. PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-400250
DOI: 10.1016/j.drup.2015.08.001
Journal or Publication Title: Drug Resist. Update
Volume: 21-22
Page Range: S. 30 - 41
Date: 2015
Publisher: CHURCHILL LIVINGSTONE
Place of Publication: EDINBURGH
ISSN: 1532-2084
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
CHRONIC PULMONARY ASPERGILLOSIS; CENTRAL-NERVOUS-SYSTEM; LIPOSOMAL AMPHOTERICIN-B; PHARMACODYNAMIC TARGET DETERMINATION; BRONCHOALVEOLAR LAVAGE FLUID; INVASIVE ASPERGILLOSIS; ANTIFUNGAL THERAPY; TR34/L98H MUTATIONS; CYP51A GENE; WILD-TYPEMultiple languages
Pharmacology & PharmacyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/40025

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