American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary treatment of choice for invasive aspergillosis?

1. Amphotericin B

2. Voriconazole

3. Itraconazole

4. Fluconazole

The correct answer is: Voriconazole

Voriconazole is considered the primary treatment of choice for invasive aspergillosis due to its specific antifungal action and pharmacokinetic profile. It is a triazole antifungal, which works by inhibiting the enzyme lanosterol 14-alpha-demethylase, crucial for ergosterol synthesis in fungal cell membranes. This mechanism effectively targets Aspergillus species, the primary pathogens responsible for this infection. In clinical practice, voriconazole has shown superior efficacy compared to other antifungals in treating invasive aspergillosis. Various studies indicate that it improves overall survival rates among affected patients compared to older antifungal options. Voriconazole also penetrates well into tissues, including the central nervous system, which is important given the potential for cerebral involvement with invasive aspergillosis. While amphotericin B remains a potent antifungal with a broad spectrum of activity, it is often reserved for cases where voriconazole is ineffective or in particular patient populations due to its toxicity profile. Itraconazole, another triazole, is generally not recommended as a first-line treatment due to its lower efficacy and variable absorption characteristics. Fluconazole does not provide adequate coverage for Aspergillus species, which is why it is not suitable as