Prevention of invasive aspergillosis in high-risk patients: Universal versus preemptive, targeted treatment

Invasive aspergillosis (IA) is associated with increased morbidity and mortality, and there is a need for better preventative and therapeutic approaches. Successful treatment of documented IA remains difficult, often because of the inability to detect disease at an early stage. An important, recent advance in the management of aspergillosis is the availability of the newer broad-spectrum azoles, voriconazole and posaconazole, which have good activity against Aspergillus spp. In addition, newer diagnostic modalities including Aspergillus galactomannan, β-glucan, and polymerase chain reaction are more readily available. These diagnostic and treatment options have made new strategies possible for the management of IA. Prophylaxis and empirical therapy for high-risk patients have been popular for decades, and now a preemptive, targeted approach to IA management has become more attractive. This article reviews strategies for the prevention and management of IA and compares and contrasts universal prophylaxis to the preemptive, targeted approach for IA in high-risk patients.