[Curative treatment of invasive aspergillosis].

Invasive aspergillosis is an opportunist infection in immunosuppressed hosts among the most difficult to diagnose and to treat. A wide variety of clinical forms exist which may not require the same treatment for each of them. Intravenous amphotericin B and itraconazole are the only available antifungal agents. Amphotericin B is often considered as the gold standard treatment despite its high toxicity particularly with high dosage (1-1.5 mg/kg/day) and its poor results namely in bone marrow transplant recipients. Lipidic amphotericin B is less toxic allowing administration of higher dose however relevant data are limited. Itraconazole is an excellent anti Aspergillus antifungal with low toxicity, however there is a wide intersubject variation in intestinal absorption. It may represent a valuable alternative to amphotericin B in case of intolerance or as a relay treatment and possibly in some cases as a first choice treatment. More studies are necessary particularly in granulopenic patients. Comparative study are urgently needed between both drugs and with new molecules to indicate the best treatment according to the clinical form. The use of hematopoietic growth factors and surgery may improve the outcome.