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Oral voriconazole for invasive fungal skull base infection

M J Parsonage1, N D Stafford, P Lillie

  • 1Department of Infectious and Tropical Diseases, Hull and East Yorkshire Hospitals NHS Trust, UK. mparsonage@btopenworld.com

The Journal of Laryngology and Otology
|December 24, 2009
PubMed
Abstract

Insights

This study shows that exclusively oral voriconazole can effectively treat invasive skull base aspergillosis in immunocompetent patients. This approach offers significant cost savings compared to intravenous treatments.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Invasive aspergillosis of the skull base is typically managed with intravenous antifungals like amphotericin or voriconazole.
  • Previous treatment strategies involved intravenous administration followed by oral voriconazole.

Observation:

  • A case of biopsy-proven, invasive aspergillosis of the skull base in an immunocompetent patient is presented.
  • The infection involved the central skull base, right orbit, and ethmoid sinus, causing displacement of the right internal carotid artery.
  • Treatment was administered exclusively via oral voriconazole on an outpatient basis.

Findings:

  • After four months of oral voriconazole treatment, computed tomography scans confirmed complete resolution of the infection.
  • The patient experienced no recurrence of aspergillosis two years post-treatment.
  • Exclusively oral voriconazole treatment resulted in substantial cost savings compared to intravenous or switch strategies.

Implications:

  • Exclusively oral voriconazole represents a cost-effective and viable treatment option for invasive skull base aspergillosis in select immunocompetent patients.
  • This approach may reduce healthcare costs associated with prolonged intravenous antifungal therapy.
  • Further research into oral-only antifungal regimens for invasive fungal infections is warranted.

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