What is the recommended treatment for a patient with chronic pulmonary aspergillosis?

The recommended treatment for chronic pulmonary aspergillosis is voriconazole, which is an azole antifungal. Voriconazole is particularly effective against Aspergillus species due to its broad spectrum of activity, ability to penetrate tissues, and favorable pharmacokinetic profile. It targets the fungal cell membrane by inhibiting the synthesis of ergosterol, which is crucial for maintaining fungal cell integrity. The use of voriconazole is often preferred in cases of chronic pulmonary aspergillosis because it has been shown to improve patient outcomes, such as decreasing morbidity and enhancing quality of life.

In comparison, while itraconazole is also an azole and has some activity against Aspergillus, voriconazole generally offers better efficacy for chronic cases. Amphotericin B, on the other hand, is a polyene that can be used in severe infections but has more side effects and potential toxicity, making it less preferable for long-term management. Micafungin is an echinocandin with limited effectiveness against Aspergillus and is typically used for other fungal infections, particularly Candida species. Thus, voriconazole is recognized as the standard of care for managing chronic pulmonary aspergillosis due to its proven effectiveness and favorable safety profile.