International Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


July 10, 2018

In This Article


European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines

Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) are strongly recommended in patients with suspicion of pulmonary invasive aspergillosis (IA).

For diagnosis, direct microscopy, preferably using optical brighteners; histopathology; and culture are strongly recommended.

Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA.

PCR should be considered in conjunction with other diagnostic tests.

Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programs.

Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported.

Combinations of antifungals as primary treatment options are not recommended.

Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment. In refractory disease, a personalized approach considering reversal of predisposing factors, switching drug class, and surgical intervention are also strongly recommended.

Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukemia or myelodysplastic syndrome receiving induction chemotherapy.

Secondary prophylaxis is strongly recommended in high-risk patients.


  • Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018 Mar 12.


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