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AMSAMSAn introduction to antimicrobial stewardshipStewardshipSurveillanceRace against resistanceABSABSABS in practice Educational ResourcesAFSAFSShape the futureAFS in practiceImplementing an AFS programmeDiagnosticsGuidelinesCase studiesAll case studiesOur CommitmentOur CommitmentOur commitment to anti-infectivesHeritageSustainability
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Support & ResourcesSupport & ResourcesVideosMaterialsOnline LearningOnline LearningHomeINSPIRE To: Change the CourseLondon AMS SeriesNorth West England AMS SeriesInfectious Thinking Podcasts

Information on how to access prescribing information and adverse event reporting can be found at the bottom of the page.

Guidelines

When developing an AFS programme, published guidelines can support the creation of your own local recommendations. Guidelines can be used to support prescribing decisions but Cresemba® (isavuconazole) should always be prescribed within its licenced indication.

 

Cresemba® (isavuconazole) is indicated in adults for the treatment of invasive aspergillosis, and of mucormycosis in patients for whom amphotericin B is inappropriate.1

Consideration should be given to official guidance of the appropriate use of antifungals.1

Summary of guideline recommendations for invasive aspergillosis2–4,a

Interventions recommended by the guidelines differ in some instances from licensed indications. Please refer to individual SPCs for full prescribing information.
Scroll left to view table
Guidelines Population Recommended treatments Preferred alternative treatments
ECIL-6 (2017)2 Leukaemia and HSCT patients Voriconazole (A I) 

Isavuconazole 
(A I/II)
Liposomal  amphotericin B 
(B I)

Amphotericin B lipid complex 
(B II)
ESCMID-ECMM-ERS (2017)3 IPA:
 
  • Neutropenic non-allo HSCT recipients
     
  • Neutropenic allo-HSCT recipients
     
  • Allo-HSCT without neutropenia or other non-neutropenic patients
Isavuconazole 
(A I/II)

Voriconazole 
(A I/II) 
Liposomal amphotericin B (B II)
Infection resistant to amphotericin B (MIC ≥1 mg/L) Voriconazole 
(B II)

Isavuconazole 
(B II)
NA
A. terreus infection Voriconazole 
(A II)

Isavuconazole 
(A II)
Posaconazole (B III)

Itraconazole (B III)
Summary of guideline recommendations for mucormycosis5,6

Interventions recommended by the guidelines differ in some instances from licensed indications. Please refer to individual SPCs for full prescribing information.
Scroll left to view table
First-line monotherapy Salvage therapy after first-line amphotericin B
All patients Liposomal amphotericin B (A II) Patients with refractory disease Isavuconazole (A II)
Isavuconazole (B II) Posaconazole DR tablet (A II)
Posaconazole DR tablet or IV (B II); oral suspension (C II) Posaconazole oral suspension (C II)

Amphotericin B liposomal (A II); lipid complex (B II)
Amphotericin B deoxycholate (D II)
Patients 
with CNS involvement
Lipsomal amphotericin B (A III)
Patients without CNS involvement Amphotericin B lipid complex (B II) Patients with toxicity or intolerance to first-line treatment Isavuconazole (A II)
Patients with pre-existing renal compromise Isavuconazole Posaconazole DR tablet (A II)
Posaconazole  Posaconazole; oral suspension (C II)

Amphotericin B liposomal (A II); lipid complex (B II)
SOT recipients Amphotericin B lipid formulation (A II) or amphotericin B lipid complex (A II)
Haematological malignancies Liposomal amphotericin B (C III)
Orbital mucormycosis Retrobulbar injection of amphotericin B deoxycholate in addition to systemic therapy (D III)

CRESEMBA® is highly recommended for the treatment of invasive aspergillosis by the latest guidelines, including ECIL-6 and ESCCMID.2-4

Shape the future (AFS) BSMM recommendations paper  Read more  Loading
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Examples of successful AFS programmes Case studiesLoading

a. Strength of recommendation - A: Good evidence to support recommendation (ECIL-6) Strongly supported (ESCMID-ECMM-ERS); B: Moderate evidence to support recommendation (ECIL-6) Moderately supported (ESCMID-ECMM-ERS); C: Poor evidence to support recommendation (ECIL-6) Marginally supported (ESCMID-ECMM-ERS); D: NA (ECIL-6) Recommendation against use (ESCMID-ECMM-ERS). Strong recommendation: most people in this situation would want the recommended course of action and only a small proportion would not (IDSA). Quality of evidence - I: ≥1 properly designed randomised controlled trial (orientated on the primary endpoint of the trial); II: ≥1 well designed clinical trial without randomisation; cohort or case-controlled analytical studies (preferably from >1 centre); multiple time series; or dramatic results from uncontrolled experiments; III: Opinions of respected authorities based on clinical experience, descriptive case studies, or reports of expert committees.2-4

ABS, antibacterial stewardship; AFS, antifungal stewardship; AMS, antimicrobial stewardship; BSMM, British Society for Medical Mycology; CNS, central nervous system; DR, delayed release; ECIL, European Conference on Infections in Leukaemia; ECMM, European Confederation of Medical Mycology; ERS, European Respiratory Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; EMA, European Medicines Agency; FDA, Food and Drug Administration; HSCT, haematopoietic stem cell transplantation; IDSA, Infectious Diseases Society of America; IPA, invasive pulmonary aspergillosis; IV, intravenous; MIC, minimum inhibitory concentration; NA, not available; PCR, polymerase chain reaction; SOT, solid organ transplant, TDM, therapeutic drug monitoring.

Prescribing Information:

Click here for CRESEMBA® (isavuconazole) and Vfend (voriconazole) prescribing information

References:

CRESEMBA GB Summary of Product Characteristics.Tissot F et al. Haematologica 2017;102(3):433–444.Ullmann AJ et al. Clin Microbiol Infect 2018;24(Suppl. 1):e1–38.Patterson TF et al. Clin Infect Dis 2016;63(4):e1–e60.Cornely OA et al. Lancet Infect Dis 2019;19(12):e405–e421.Cornely OA et al. Lancet Infect Dis 2019;19(12):e405–e421. (Appendix).
PP-CRB-GBR-1638. August 2022.

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Adverse events should also be reported to Pfizer Medical Information on 01304 616161

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