{"id":2625,"date":"2016-07-13T06:57:16","date_gmt":"2016-07-13T10:57:16","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=2625"},"modified":"2025-09-20T19:21:04","modified_gmt":"2025-09-21T01:21:04","slug":"aspergillus_guideline-zip","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2016\/07\/13\/2625\/aspergillus_guideline-zip\/","title":{"rendered":"Aspergillus_Guideline.ZIP"},"content":{"rendered":"

\"Rules-Regx-Guidelines<\/a><\/p>\n

Now, I know we should not make light of any IDSA Guidelines, far from it. This latest, the Aspergillus Guideline [1]<\/a>, like others before, is a thoughtful document which reviews the newest information and reflects expert authoritative thinking on the subject. It also is a hefty 60 pages long, as seems to become the norm for these documents nowadays.<\/p>\n

Hey, no problem for my electronic bookshelf \u2013 bring \u2018em on!\u00a0 As I think about it, every bug causing infection will eventually get its own guideline.\u00a0 Soon, there will no longer be a need for monographs or textbooks, \"Aspergillus<\/a>instead we will have a \u2018living library\u2019 of thousands of guideline pages. Mandell\u2019s will be replaced by a Guideline Encyclopedia Universalis Infectiologica.<\/p>\n

Who can keep up with this? What the busy clinician really needs is something more succinct. The poor fellow who would so much like to stay current but simply cannot cope (he just read 3 versions of hepatitis C guidelines in rapid succession!) should get a break.<\/p>\n

We would like to offer a succinct version in this blog, highlighting core messages and new recommendations. Nothing else, just the key points.\u00a0 Call it the Cliff Notes for ID Guidelines or the Quick Take-Aways for the busy ID doc, below the abridged Aspergillus Guideline, unabashedly condensed.\u00a0 Just don\u2019t call it Aspergillus for DUMMIES, please.<\/p>\n

Here is our zipped version:<\/p>\n

    \n
  1. Keep exposure of high-risk patients to molds low and perform surveillance checks<\/li>\n
  2. Galactomannan testing on serum or BAL is useful for diagnostics and f\/u<\/li>\n
  3. Chest CT is useful for diagnosis and f\/u<\/li>\n
  4. 1st<\/sup> line treatment of invasive aspergillosis (IA) is voriconazole, with liposomal AMB or isavuconazole as 2nd<\/sup> line agents<\/li>\n
  5. Prophylaxis of invasive aspergillosis (IA) should be with voriconazole or posaconazole<\/li>\n
  6. Check trough levels at steady state, esp. for voriconazole<\/li>\n
  7. For azoles with a propensity for DDI, monitor therapeutic levels of concomitant therapies (tacrolimus, cyclosporine, TKIs)<\/li>\n
  8. Routine antifungal susceptibility testing is not advisable<\/li>\n<\/ol>\n

    If this sounds a bit anticlimactic, you are correct. Since the last aspergillus guidelines in 2008, there has been little significant progress overall, with small steps here and there but we had no major breakthroughs. We are missing a new class of antifungals that would change the field like the candins did for candidiasis. The candins have yet to prove efficacy in aspergillosis in a convincing study. Besides the arrival of a new azole (isavuconazole), only the diagnostics have brought some improvement in care and advanced the field.<\/p>\n

    The full guidelines contain a lot more, of course. They also address pediatric IA, the approach to non-responders, extrapulmonary aspergillosis and controversies (candins for IA, febrile neutropenia). There is also a section on allergic pulmonary aspergillosis. For that rare case of aspergillus ophthalmitis, I trust you will refer to the newest Guidance and other source documents for advice when the time comes and you are confronted with such a case.<\/p>\n

    Let us know how you feel about Guidelines by taking the short poll below
    \nTHANK YOU!<\/span><\/p>\n

    [poll id=”7″]<\/p>\n

    \n

    Abbreviations:
    \n<\/strong>TKI\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 tyrosine kinase inhibitor
    \nDDI \u00a0 \u00a0 \u00a0 drug-drug interactions
    \nIA\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 invasive aspergillosis
    \nTDM\u00a0\u00a0\u00a0\u00a0\u00a0 therapeutic drug monitoring<\/p>\n

    Reference:
    \n<\/strong>    [1]<\/a> T Patterson. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases Advance Access published June 29, 2016<\/p>\n","protected":false},"excerpt":{"rendered":"

    Now, I know we should not make light of any IDSA Guidelines, far from it. This latest, the Aspergillus Guideline [1], like others before, is a thoughtful document which reviews the newest information and reflects expert authoritative thinking on the subject. It also is a hefty 60 pages long, as Continue reading Aspergillus_Guideline.ZIP<\/span>→<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":2627,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[227,3,18],"tags":[1271,403,888,942,123,1698,1583,1485,1697,610,979,980,938,928],"class_list":["post-2625","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-recent_literature","category-the_news","category-the_viewpoint","tag-allphase-pharma-consulting","tag-antibiotic-blog","tag-aspergillosis","tag-cresemba","tag-drug-interactions","tag-galactomannan-test","tag-harald-reinhart","tag-idsa-guideline","tag-invasive-aspergillosis","tag-isavuconazole","tag-tdm","tag-therapeutic-drug-monitoring","tag-vfend","tag-voriconazole"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Rules-Regx-Guidelines-slider.jpg?fit=640%2C180&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-Gl","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":4964,"url":"https:\/\/allphasepharma.com\/dir\/2025\/08\/15\/4964\/new-idsa-cuti-guideline\/","url_meta":{"origin":2625,"position":0},"title":"NEW IDSA cUTI GUIDELINE","author":"Harald","date":"August 15, 2025","format":false,"excerpt":"A new Guideline for the treatment of cUTI just arrived.[1] First, we are glad that this somewhat mundane topic receives the attention it deserves.\u00a0 UTIs are often downplayed as minor infections, but the cUTI variety should not be taken lightly.\u00a0 Many patients still are admitted with life-threatening infections, so prompt\u2026","rel":"","context":"In "The News"","block_context":{"text":"The News","link":"https:\/\/allphasepharma.com\/dir\/category\/the_news\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/08\/cUTI-classification.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/08\/cUTI-classification.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/08\/cUTI-classification.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/08\/cUTI-classification.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/08\/cUTI-classification.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":222,"url":"https:\/\/allphasepharma.com\/dir\/2014\/05\/30\/222\/hiv-therapy-guidance-recommendations-diverge-show-us-bias\/","url_meta":{"origin":2625,"position":1},"title":"HIV Therapy Guidance Recommendations Diverge, Show US Bias","author":"Harald","date":"May 30, 2014","format":false,"excerpt":"US doctors seem to be very willing to start drugs earlier in disease, while their EU colleagues are slower and more conservative.\u00a0 Recent examples: the ever-wider indication for statins, the disproportionate uptake of drugs for attention-deficit \/ hyperactivity and opioids for pain relief.\u00a0 The new US HIV treatment guidelines are\u2026","rel":"","context":"In "The Viewpoint"","block_context":{"text":"The Viewpoint","link":"https:\/\/allphasepharma.com\/dir\/category\/the_viewpoint\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":2233,"url":"https:\/\/allphasepharma.com\/dir\/2016\/01\/02\/2233\/new-treatment-guidelines-for-candidiasis-a-major-document-to-study\/","url_meta":{"origin":2625,"position":2},"title":"New Treatment Guidelines for Candidiasis \u2013 A Major Document to Study","author":"Harald","date":"January 2, 2016","format":false,"excerpt":"In a much-quoted analysis, Lee found that most IDSA Guidelines were supported only by Level III quality data, the lowest category of evidence-based support[1]. The article concludes that more well-designed trials were needed, and clinical judgement should ultimately guide patient management. This all sounds fine and good, and the new\u2026","rel":"","context":"In "Recent Literature"","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"InExpertsWeTrust","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/01\/InExpertsWeTrust.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/01\/InExpertsWeTrust.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/01\/InExpertsWeTrust.jpg?resize=525%2C300 1.5x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/01\/InExpertsWeTrust.jpg?resize=700%2C400 2x"},"classes":[]},{"id":182,"url":"https:\/\/allphasepharma.com\/dir\/2014\/04\/24\/182\/so-many-hcv-guidelines-cant-we-wait-till-the-dust-has-settled\/","url_meta":{"origin":2625,"position":3},"title":"So Many HCV \u201cGuidelines\u201d: Can\u2019t We Wait Till the Dust Has Settled?","author":"Harald","date":"April 24, 2014","format":false,"excerpt":"It was clear from the outset that the new roster of HCV drugs would change the playing field. Gilead\u2019s NS5B polymerase inhibitor sofosbuvir and J&J\u2019s NS3\/4A protease inhibitor simeprevir have already revolutionized the treatment paradigm, pushing telaprevir and boceprevir, the first-generation PIs, to the sidelines. For treatment-na\u00efve patients with GT1,\u2026","rel":"","context":"In "The Viewpoint"","block_context":{"text":"The Viewpoint","link":"https:\/\/allphasepharma.com\/dir\/category\/the_viewpoint\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1769,"url":"https:\/\/allphasepharma.com\/dir\/2015\/07\/28\/1769\/the-demise-of-kb001-part-2-an-anti-pseudomonas-antibody-hits-the-dust-instead-of-paydirt\/","url_meta":{"origin":2625,"position":4},"title":"The Demise of KB001 (Part 2): An Anti-Pseudomonas Antibody Hits the Dust (instead of Paydirt)","author":"Harald","date":"July 28, 2015","format":false,"excerpt":"FOR\u00a0PART 1, CLICK HERE Should we assume that the results of this Global Epi Study were the reason why Sanofi became disillusioned about the prospects of KB001? \u00a0Or was it an internal strategic decision based on portfolio-review where KB001 just no longer made the cut? The results of the Global\u2026","rel":"","context":"In "The News"","block_context":{"text":"The News","link":"https:\/\/allphasepharma.com\/dir\/category\/the_news\/"},"img":{"alt_text":"KB Part 2 NEW","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/07\/KB-Part-2-NEW.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/07\/KB-Part-2-NEW.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/07\/KB-Part-2-NEW.jpg?resize=525%2C300 1.5x"},"classes":[]},{"id":2112,"url":"https:\/\/allphasepharma.com\/dir\/2015\/11\/09\/2112\/the-fda-amdac-on-fluoroquinolones-part-2-where-were-the-fq-advocates\/","url_meta":{"origin":2625,"position":5},"title":"The FDA AMDAC on Fluoroquinolones (Part 2): Where Were the FQ Advocates?","author":"Harald","date":"November 9, 2015","format":false,"excerpt":"Any FDA meeting is a high-stakes game for industry: \u00a0One never knows how the discussions will go. Some oddball issue may take center stage and usurp much time, creating an unbalanced perspective.\u00a0 At other times, simple issues seem to create controversy, questions are not properly understood in the context of\u2026","rel":"","context":"In "The News"","block_context":{"text":"The News","link":"https:\/\/allphasepharma.com\/dir\/category\/the_news\/"},"img":{"alt_text":"AMDAC Part 2 - slider","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/11\/AMDAC-Part-2-slider.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/11\/AMDAC-Part-2-slider.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/11\/AMDAC-Part-2-slider.jpg?resize=525%2C300 1.5x"},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/2625","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/comments?post=2625"}],"version-history":[{"count":9,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/2625\/revisions"}],"predecessor-version":[{"id":5308,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/2625\/revisions\/5308"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/media\/2627"}],"wp:attachment":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/media?parent=2625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/categories?post=2625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/tags?post=2625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}