What is the drug of choice for severe or invasive aspergillosis?

• A. Voriconazole
• B. Fluconazole
• C. Ketoconazole
• D. Griseofulvin

Answer: (A)

Treating invasive aspergillosis requires a mold-active antifungal with strong activity against Aspergillus, good tissue penetration, and proven impact on survival. Voriconazole fits this best because it has potent antifungal activity specifically against Aspergillus species and, in clinical trials, provided a survival advantage compared with the older standard therapy, amphotericin B. It also offers both intravenous and oral formulations, which is important for rapid initiation of therapy and for stepping down as the patient improves, while achieving good tissue and CNS penetration. The other choices are less suitable: fluconazole has little to no activity against Aspergillus and is reserved for Candida infections; ketoconazole and griseofulvin are not reliable for invasive Aspergillus disease and are used for different indications. Therefore, voriconazole is the drug of choice for severe or invasive aspergillosis.