Recommendations for managing Aspergillus osteomyelitis and joint infections based on a review of the literature

SummaryObjectivesTo produce recommendations for the management of Aspergillus osteomyelitis and joint infections.MethodsPublished 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.ResultsSuccessful 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.ConclusionsFor 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.