Monitoring
Invasive aspergillosis:
Clinical symptoms of invasive aspergillosis rapidly improve after a few days of initiation of therapy.
In cases of sino-pulmonary aspergillosis or cerebral infections, computed tomography (CT)/magnetic resonance imaging (MRI) every 2 or 4 weeks are required to assess progress. Radiological findings may gradually stabilise and show no further improvement, indicative of scarring and fibrosis. Serological markers (serum galactomannan [GM] or serum beta-D-glucan) show gradual improvement with therapy; weekly monitoring until there is substantial improvement is reasonable.
Chronic pulmonary aspergillosis:
Follow-up imaging with chest x-ray (CXR) or CT is recommended every 3-6 months after initiating antifungal therapy to assess the efficacy of treatment (measured by extent of consolidation, cavity wall thickness and size, aspergilloma and pleural thickening).[3]
In asymptomatic patients with aspergilloma, periodic monitoring with CXR is appropriate.
Drug monitoring:
As with all triazoles, voriconazole is metabolised via the hepatic cytochrome p450 system, through which many other drugs are metabolised; hence, drug interactions are frequent.[131] The serum concentration of drugs (e.g., tacrolimus, ciclosporin, voriconazole) needs close monitoring with appropriate dose adjustments to ensure efficacy and avoid toxicity.[132][133][134] With prolonged therapy, voriconazole levels may decrease. If improvement is delayed, serum concentration of voriconazole/isavuconazole/posaconazole should be checked. In areas of high prevalence of azole-resistance, routine susceptibility testing of aspergillus should be considered.
In asymptomatic patients with aspergilloma, periodic monitoring with CXR is appropriate.
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