TREATMENT OF
NON-ASPERGILLUS MOLD INFECTIONS

Learn about the treatment options for non-Aspergillus mold infections.

**TREATMENT OF NON-ASPERGILLUS MOLD INFECTIONS**

An invasive infection with a non-Aspergillus mold is a serious medical condition. It is critically important to prevent as many of these infections as possible and aggressively treat them when they occur. Some general considerations for prevention and treatment include:

Careful consideration of prophylaxis. Antifungal prophylaxis practices vary from provider to provider and from institution to institution. Most providers are careful to only use antifungal prophylaxis in patients who are at very high risk for non-Aspergillus mold infection. Other providers do not use prophylaxis at all for their high-risk patients. Why be so careful with prophylaxis? Reasons include: cost of therapy, side effects, interactions with other drugs. Antifungal prophylaxis is generally thought of as preventing aspergillosis, though many of the antifungal medications used for this purpose also help prevent non-Aspergillus mold infections.

Early treatment if possible. Prompt diagnosis and management of invasive fungal infections, regardless of specific pathogen, improve outcomes. Sometimes, clinicians will treat empirically for invasive mold infection, particularly in someone who has long-standing neutropenia (low white blood cells of a specific type) and a fever that has not gone away despite broad-spectrum antibiotic therapy. However, whenever possible, it’s best to initiate diagnostic testing to establish a fungal infection in such patients. When therapy is guided by such testing, it’s called pre-emptive. In many cases, it is preferred to reduce immunosuppression (for example, decreasing or holding chemotherapy) when possible to allow the immune system to better fight the infection. Your provider may choose a broad-spectrum drug to cover the widest variety of molds. To learn more about the spectrum of activity of drugs for invasive molds, see SCIENCE SIDEBAR: SPECTRUM OF ACTIVITY OF ANTIFUNGALS AGAINST INVASIVE MOLDS.

Assessing the Potential Effectiveness of the Antifungal. Non-Aspergillus molds do not uniformly respond to antifungal medications. In other words, antifungal medications can be highly effective for some non-Aspergillus molds but ineffective against others. In some cases, simply identifying the specific fungus can give critical insights into which antifungal medication will be effective. For example, voriconazole will likely be effective against Scedosporium, but ineffective against Rhizomucor. However, we don’t have great antifungal susceptibility surveillance for every possible non-Aspergillus mold, and we have somewhat limited antifungal susceptibility testing. In fact, because the list of potential non-Aspergillus molds is so extensive, experts recommend that providers directly test the effectiveness of each antifungal against the specific fungus causing a patient’s infection.

Addressing pharmacology. Many of the patients receiving antifungal medications for invasive infection with a non-Aspergillus mold have weakened immune systems or are very sick. These patients are likely to receive other medications that can possibly affect the levels of the antifungal drug. In addition, their kidneys and livers may not be working well. For these reasons, the provider needs to be cognizant of all the factors that could affect the antifungal drug levels. There’s a “Goldilocks zone” with most antifungal drug levels—too little drug and you don’t get efficacy, too much drug and there can be side effects, the “just right” level is the most effective and safe. For these reasons, providers may use antifungal therapeutic drug monitoring to make sure the drug levels are in the right range.

Science Sidebar:

Spectrum of Activity of Antifungals Against Invasive Molds

Spectrum of activity is used to describe how drugs work against a range of pathogens. Why is this important? It’s best to start therapy early for mold infections, and so a drug that works for a range of molds (broad spectrum) is often used first. However, different drugs—even within the same class of agents—might not work well against all molds (ie, they have “holes” in their spectrums).

For example, we know that voriconazole, which is an azole drug, works well against Aspergillus. However, if we start voriconazole treatment for a mold infection and find out it is actually caused by a fungus belonging to the order Mucorales, then we have the following pattern of response:

Resistant to: fluconazole, voriconazole, and echinocandins
Limited response to: itraconazole and terbinafine
Response to: amphotericin B, isavuconazole, and posaconazole

If you are on antifungal medication and you experience a breakthrough infection, your doctor will look at the known spectrum of activity of the initial drug to help piece together the likely fungus that has broken through. And this is why it’s important to continually use diagnostics as we chase down the fungus.

TREATMENT OPTIONS

Treatment of invasive infection with a non-Aspergillus mold typically requires a treatment plan that is individualized to each patient. There is not a single treatment approach that will work for every patient or for every fungal pathogen. However, there are some general principles that tend to apply in most situations.

For the most severe forms of infection and/or when the fungal pathogen has not been identified, amphotericin B is usually the preferred empiric or pre-emptive antifungal treatment. Once the fungal species has been identified and the patient is stable, step-down or consolidation antifungal can be considered. The choice of specific antifungal treatment in this stage of therapy is often informed by the results of antifungal susceptibility testing.
Many invasive infections with non-Aspergillus molds require surgical debridement (removal of infected tissue by a surgeon in the operating room) in combination with antifungal medications.
In some cases, more than one antifungal medication is used for a combination effect, though this approach is only recommended for specific pathogens and as salvage treatment.
Host factors—control of the underlying disease or strategies to improve the host’s immune response—are also tools that your doctor may consider in helping you clear the infection. If a patient receiving a stem cell transplant has underlying diabetes mellitus, the team will work together to get the diabetes under control, since it is a risk factor. Also, if a patient has a really low neutrophil count, the provider may consider colony stimulating factors to boost the white cell count. Finally, if a patient is receiving immunosuppressive therapy, the doctor will consider reducing those medicines, if possible, to enable the immune system to help clear the infection.

Antifungal Treatments

In this section, we go over the drugs and other treatments used to manage invasive infection with non-Aspergillus molds, with a brief discussion of investigational therapies as well. As previously mentioned, amphotericin is often the best empiric antifungal while awaiting fungal identification and antifungal susceptibility testing as appropriate. Prior to the introduction of the triazole antifungals, amphotericin was the only antifungal available to treat invasive infection with non-Aspergillus molds. You will notice that it is the drug that was used as the comparator in many of the older studies.

We have arranged the drugs in alphabetical order by class of drug because sometimes your doctor will recommend switching the antifungal drug class or combining classes of drugs when the first treatment is not effective. It’s important to note that we provide generalizations about these therapies. Your provider will work with you to determine the best course of therapy for you. Your provider will consider the type of non-Aspergillus mold infection you have, your medical history, and other factors such as kidney function, other medicines you are taking, and whether you are pregnant or breastfeeding when selecting your therapy.

While all the drugs listed below are FDA-approved, most are only approved for treatment of specific types of fungal infections. In general, obtaining approval for every type of fungus is not possible. But just because FDA-approval only covers some situations, it does not mean researchers have not performed some testing for efficacy for other non-FDA approved indications. Sometimes that research does not lead to an FDA approval for the indication. To learn more about the barriers to FDA approval for rare mold infections, see the POLICY SIDEBAR: THE REGULATOR HURDLES FOR APPROVING DRUGS FOR RARE MOLD INFECTIONS.

When an antifungal medication is used to treat a fungal infection not explicitly approved by the FDA, it is called “off-label” use. Off-label use of antifungal medications is common and is not usually cause for concern. We’ve provided some resources on the use of the drugs for non-Aspergillus molds, but this information is not exhaustive. We’ve included data for mucormycosis, fusariosis, lomentaosporiosis, scedosporiosis, and phaeohyphomycosis. For data on therapies for these other rare molds, please see the summary by Martin et al. The Infectious Diseases Society of America (IDSA) does not provide guidelines for management of non-Aspergillus molds, but we have referenced some other international guidelines because they provide summaries of the studies for individual molds. Ultimately, your healthcare provider should be able to answer questions regarding their recommended antifungal treatment.

Finally, all the data discussed are related to management of non-Aspergillus molds in adults. Information for pediatric patients is coming in a later module.

POLICY SIDEBAR:

THE REGULATOR HURDLES FOR APPROVING DRUGS FOR RARE MOLD INFECTIONS

A doctor diagnoses a patient with a rare mold infection. There is no treatment specifically approved by the Food and Drug Administration (FDA) for that infection, so the doctor recommends an FDA-approved drug off-label. Why does this happen? To understand why, we need to talk a little about how drugs are approved in the United States.

Normally, for a new drug to be approved in the United States, studies are required in which the researcher randomly assigns potential patients to either the drug being studied or to standard of care or placebo. The controlled study is then conducted in a double-blind manner. Such studies typically require a lot of people and take a long time. For example, for an Aspergillus study, this might require 100 institutions, enroll 500 people, and take 5 years!

How is that regulatory pathway going to work for a rare, non-invasive mold or an emerging resistant fungus? That model does not work well in those cases. We are seeing some alternative approaches to drug approval for rare fungi, including the use of single-arm, open-label studies comparing results to natural history controls. Often, the drug approval is supported by animal studies, laboratory studies, and data from the use of a drug for other indications. Rare disease organizations in cancer and inherited disorders of metabolism have helped develop even more streamlined pathways to drug approval. See the article to learn more about these novel studies.

MyCARE is actively supporting streamlined regulatory approaches to antifungal drug approval. We are collaborating with rare disease organizations and policymakers to advocate for approval pathways that help us gain access to antifungal drugs quickly while still assuring they are effective and safe. To learn more about our regulatory or policy efforts and how you might help, contact our policy lead, Robert Purdie at rpurdie@fightfungus.org.

TREATMENT OPTIONS

Polyenes

These drugs are derivations of amphotericin B and are named for their chemical structure. At this time, these drugs must be given by vein, but a version that can be delivered by mouth is being studied (See Clinical Trials). We list these agents first since they are the preferred therapies for non-Aspergillus molds.

Amphotericin B Deoxycholate (conventional amphotericin), IV

HOW IT IS GIVEN: By vein (intravenous)

APPROVAL STATUS: Amphotericin B is approved for treatment of potentially life-threatening infections. Specific to non-Aspergillus molds, it is approved for mucormycosis due to susceptible species of the genera Absida, Mucor, and Rhizopus and infections related to suspectable species of Conidiobolus and Basidiobolus.

HOW WELL IT WORKS: It is rarely used anymore because the lipid forms of amphotericin B are safer for the kidneys. It also appears to be less effective than the lipid formulations for non-Aspergillus molds. To learn about the studies of amphotericin B for individual molds, go here.

COMMON SIDE EFFECTS: Fever, low blood pressure, upset stomach, loss of appetite, vomiting, diarrhea, anemia, kidney damage, liver damage, allergic reaction

Amphotericin B lipid complex (ABLC, ABELCET^®), IV

HOW IT IS GIVEN: By vein (intravenous)

APPROVAL STATUS: ABLC is indicated for the treatment of invasive fungal infections in patients who are refractory to or intolerant to conventional amphotericin B. The label does not specifically mention indications for Aspergillus molds.

HOW WELL IT WORKS: ABLC has some supporting data in managing mucormycosis. It has also been studied alone or in combination with voriconazole for fusariosis. To learn about the supporting studies, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Chills, fever, kidney problems, organ failure

FINANCIAL SUPPORT: Leadient Biosciences Patient Assistance Program: 800-490-3262

Liposomal amphotericin B (AmBisome^®)

HOW IT IS GIVEN: By vein (intravenous)

APPROVAL STATUS: Not specifically indicated for non-Aspergillus molds, but it is approved as empirical therapy for presumed fungal infections in febrile, neutropenic patients.

HOW WELL IT WORKS: Is supported by data for mucormycosis, alone or in combination with caspofungin; potentially for Lomentosporum prolificans in combination with voriconazole; and for fusariosis, alone or in combination with voriconazole. To learn about the support for liposomal amphotericin B, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Rash, high blood sugar, electrolyte abnormalities, nausea, vomiting, low blood count, liver function abnormalities, chills, trouble sleeping, kidney function abnormalities, shortness of breath

Triazoles

Triazoles are also used for the management of non-Aspergillus molds. Many of these medicines can be provided both by mouth and vein. They are named by their chemical structure. Azoles can interact with a lot of medications, so your provider will need to consider all the medications you are taking when starting azole therapy. The FDA-approved azoles are listed first.

Isavuconazonium sulfate (CRESEMBA^®)

HOW IT IS GIVEN: By vein (intravenous) and by mouth (capsules)

APPROVAL STATUS: FDA approved for treatment of invasive mucormycosis

HOW WELL IT WORKS: In the VITAL single-arm, open-label trial, isavuconazole had similar efficacy to amphotericin B controls for the management of invasive mucormycosis. The drug was well tolerated. To learn more about the VITAL study, see here. It also has some support for use in fusariosis, lomentosporiosis, scedosporiosis, and for phaeohyphomycosis infections. To learn about the supporting studies, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Vomiting, nausea, diarrhea, liver problems, electrolyte problems, shortness of breath, swelling of arms or legs, back pain, headache

FINANCIAL RESOURCES: CRESEMBA^® Support Solutions. Call 1-800-477-6472 or visit the Support Solutions Page.

For patient information, see the Cresemba website.

Itraconazole (SPORANOX^®, ONMEL^®, suba-itraconazole, TOLSURA^®)

HOW IT IS GIVEN: By mouth, capsule, or oral solution

APPROVAL STATUS: Not approved for any non-Aspergillus invasive mold infections

HOW WELL IT WORKS: Has scarce data to support use in scedosporiosis and localized phaeohyphomycosis: To learn about the supporting studies, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Vomiting, diarrhea, abdominal pain, dizziness, drowsiness, rash, headache, blurred vision, liver damage, joint pain, heart problems, swelling. It also has a number of drug-drug interactions.

Posaconazole (NOXAFIL^®)

HOW IT IS GIVEN: By vein (intravenous) or by mouth (delayed-release tablets or an oral suspension)

APPROVAL STATUS: Posaconazole is not specifically indicated for treatment of non-Aspergillus molds, but it is indicated for prophylaxis of invasive Aspergillus and Candida infections in patients who are high risk of developing those infections due to being severely immunocompromised.

HOW WELL IT WORKS: Posaconazole has support for use in mucormycosis, scedosporiosis (alone or in combination with terbinafine), lomentosporiosis, and as second-line therapy for fusariosis. To learn about the supporting studies, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Gastrointestinal side effects (abdominal pain, constipation, diarrhea, nausea, vomiting), fever, swelling, low blood count, liver enzyme elevations

FINANCIAL RESOURCES: NOXAFIL^® Merck Patient Assistance Program. Call 800-727-5400 or visit www.merckhelps.com/NOXAFIL

Voriconazole (VFEND^®)

HOW IT IS GIVEN: By vein (intravenous) or by mouth (tablets or suspension)

APPROVAL STATUS: Voriconazole is FDA approved for serious fungal infections caused by Scedosporium apiospermum and Fusarium species, including Fusarium solani, in patients intolerant of, or refractory to, other therapy

HOW WELL IT WORKS: In pooled analyses, 63% (15/24) of patients with Scedosporium apiospermum had a successful response to voriconazole. In fusariosis, 43% (9/21) patients were successfully treated with voriconazole. To learn more about these studies, see the VFEND Prescribing information. Voriconazole also has activity against Lomentospora prolificans, alone or in combination. It also has activity against some of the phaeohyphomycosis. To learn about the supporting studies, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Visual disturbances, nerve problems, liver problems, heart rhythm problems, bone problems, and interactions with other drugs; long-term use: skin sensitivity and skin cancer

Echinocandins

Echinocandins are medications given by vein that inhibit the synthesis of part of the fungal cell wall. These drugs are typically used as part of a combination approach for non-invasive molds.

Anidulafungin (Eraxis^®)

HOW IT IS GIVEN: By vein (intravenous)

APPROVAL STATUS: Not FDA approved for non-Aspergillus mold infections

HOW WELL IT WORKS: Echinocandins are supported in combination therapy approaches for mucormycosis, scedosporiosis, and phaeohyphomycosis. To learn about the supporting studies for echinocandins as part of combination therapy for non-Aspergillus molds, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Low blood pressure, high blood pressure, shortness of breath, blood clots, blood electrolyte problems, liver function abnormalities, trouble sleeping

Caspofungin (Cancidas^®)

HOW IT IS GIVEN: By vein (intravenous)

APPROVAL STATUS: Caspofungin is not approved specifically for non-Aspergillus mold infections. However, it is approved for presumed fungal infections in febrile patients with neutropenia.

COMMON SIDE EFFECTS: Not common: Fever, complications in the vein where the drug was infused, nausea, vomiting, flushing, abnormalities in liver function, other laboratory test abnormalities

Micafungin (Mycamine^®)

HOW IT’S GIVEN: By vein (intravenous)

APPROVAL STATUS: Micafungin is not FDA approved for non-Aspergillus mold infections.

COMMON SIDE EFFECTS: Diarrhea, agitation, headache, black stools, breathing problems, decreased urination, belly pain, tiredness, and bleeding or bruising

Rezafungin (Rezzayo^®)

HOW IT IS GIVEN: By vein (intravenous)

APPROVAL STATUS: Not FDA-approved for non-Aspergillus molds

HOW WELL IT WORKS: Echinocandins are supported in combination therapy approaches for mucormycosis, scedosporiosis, and phaeohyphomycosis. These guidelines are not inclusive of rezafungin data. To learn about the support for echinocandins as part of a combination approach for rare molds, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Flushing, warm sensations, hives, nausea, tightness in the chest (infusion reaction), sensitivity to the sun, abnormal liver tests

Allylamines

Allylamines are a class of antifungal drugs that work by inhibiting an enzyme that is involved in making the cell wall. These agents are used extensively in the management of dermatophyte infections, which is outside the scope of this section. But since the allylamine terbinafine is used for the management of non-Aspergillus invasive molds, we have included information here.

Terbinafine (generic only, Lamisil^® has been discontinued)

HOW IT IS GIVEN: By mouth (tablets)

APPROVAL STATUS: Not approved for invasive non-Aspergillus mold infections

HOW WELL IT WORKS: Terbinafine is supported for use in combination for scedosporiosis and infections caused by Lomentospora prolificans. To learn more about the use of terbinafine in combination therapy for rare molds, review the Australasian non-Aspergillus mold guidelines and the mucormycosis and rare molds guidelines from the European Confederation of Medical Mycology (ECMM).

COMMON SIDE EFFECTS: Headache, diarrhea, rash, upset stomach, liver problems, itching, disturbed taste, nausea, belly pain, flatulence

Clinical Trials and Investigational Agents

Clinical trials are research studies that test how well new treatment approaches work. They have an important place in your care as researchers strive to improve current treatments for non-Aspergillus molds and search for new and better ones. Clinical trials are essential for learning about the management of non-Aspergillus mold infections.

Our most effective antifungal treatments would not be available without the clinical trial process. Unfortunately, many people with non-Aspergillus molds, or their loved ones, are unaware of the option for a clinical trial or are unsure about the value of participating.

Your goal is to find the best treatment available whenever you make a treatment decision. While there may be a good standard of care for you or your loved one—care that experts believe is appropriate for your specific diagnosis and treatment history—sometimes the current standard of care is not as effective as you and your healthcare team would like. Other times, the standard of care works for a time but then stops working. In still other instances, there is no standard of care for your situation. Participation in a clinical trial may be the best option for you.

The best time to search for clinical trials is every time you are faced with a treatment decision. At the time this website was developed, there are some promising therapies in development that have activity against non-Aspergillus molds. At this time, it is not clear if any of these therapies will pursue FDA-approval specifically for any non-Aspergillus mold infections.

Olorofim is an oral drug that belongs to a novel class of drugs called orotomides. It can penetrate the lung, liver, kidney and brain and has low potential for drug-drug interactions. Olorofim has promising activity against several non-Aspergillus mold species. For a summary of data on olorofim for a range of fungi, see here.
Fosmanogepix is another drug using a unique mechanism of action—this IV and oral drug interferes with an enzyme necessary for fungal adherence. It also has broad activity against a non-Aspergillus mold species. For a summary of data on fosmanogepix for a range of fungi, see here.
Ibrexafungerp belongs to a new class called the triterpenoid class, which has some similarities to echinocandins but with lower rates of cross-resistance. This drug interferes with the building of the fungal cell wall. FDA-approved for vulvovaginal candidiasis treatment and prevention, ibrexafungerp has efficacy against invasive mucormycosis in animal models and some activity against other non-Aspergillus molds in the laboratory setting. To learn more about the potential role of ibrexafungerp for non-Aspergillus molds, see here.
Opelconazole is a triazole drug specifically designed for inhalation therapy. Inhalation therapy for invasive pulmonary mold infections is appealing because it gets the drug to the areas needed with fewer side effects and drug-drug interactions. Opelconazole shows activity against a number of non-Aspergillus mold species. To review these data, see here.
MAT2203 is an oral and non-toxic encochleated form of amphotericin B (CamB). Encochleation means that the drug is wrapped up in fat-based crystals and calcium that protect the drug from getting broken down within the GI tract. Encochleation also allows the drug to be taken up into the bloodstream and released in tissue because of calcium differences. MAT2203 has some positive outcomes in non-Aspergillus molds including Fusarium, as reported in a case series from compassionate use.
Otesaconazole is a drug that belongs to the tetrazole class. It was designed to be more selective for the fungal enzyme CYP51, providing better efficacy with fewer side effects than triazoles. Oteseconazole, which is FDA-approved for vulvovaginal candidiasis, has shown some efficacy in animal models of mucormycosis.

Key Terms:

Antifungal susceptibility testing is a laboratory test performed to estimate how effective different antifungal agents are against a fungus that is causing an infection. This testing helps clinicians determine if a fungus is resistant to the antifungals being considered.

Breakthrough infection is a fungal infection that occurs during exposure to an antifungal drug.

Broad-spectrum is a type of antimicrobial therapy that is effective against a wide range of pathogens.

Compassionate use is a pathway for a patient to gain access to an investigational treatment outside of a clinical trial. It is reserved for patients with serious or immediately life-threatening conditions. when there is no satisfactory alternative options. It is also called expanded access.

Controlled refers to a study that has a comparator group, a control.

Double-blind is a type of study in which neither the researchers nor the participants know which treatment the participants are receiving until the trial is over. This helps eliminate bias in the study.

Empiric is a type of therapy based on clinical experience in the absence of complete information such as diagnostic testing.

Natural history group in a drug trial is a group that receives no treatment of any kind and shoes illness runs its “natural course.”

Neutropenia refers to low blood levels of infection-fighting white blood cells called neutrophils. Neutropenia is often the result of cancer treatments or a cancer of the blood itself.

Off-label is the use of an FDA-approved drug for a condition for which it is not approved. For example, use of a drug approved for invasive aspergillosis for fusariosis would be an off-label use.

Open-label is a study that is non-blinded. Both the researchers and the patients are aware of the drug or treatment being provided.

Placebo is a treatment that has no active properties. It is sometimes used as the control arm. It is usually given the same way as the study drug to maintain double-blinding.

Prophylaxis is an action taken to prevent a disease. For some patients who are immunocompromised, antifungals can be used as prophylaxis in an attempt to prevent the development of fungal disease.

Randomization is the clinical-trial process by which study subjects (patients) are assigned by chance to separate groups that are given different treatments (for example, the drug being studied or standard of care).

Single-arm refers to a study that has one arm—the study drug. There is no comparator group who receives standard of care or placebo in a single-arm study.

Standard of care is therapy that is given routinely for a given condition. For some clinical trials, study drugs are compared with standard-of-care therapy to determine if the treatment is a significant improvement over the current treatment.

Therapeutic drug monitoring is testing to measure the amount of medication in the blood. Typically, there are target blood levels for each drug to promote safety and efficacy.

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Questions to ask your doctor about treatment for a non-Aspergillus mold infections

Have you diagnosed me with an invasive mold infection? If so, what is the mold?
How rare is my infection? How many cases have you managed?
What drug are you going to use first?
How do I take that medication?
For how long will I have to take that medication? Will you have to make any changes to my treatment?
Is that drug FDA-approved to treat this infection?
If the therapy is not FDA-approved for my mold, what is the evidence that it works for my infection?
Will you specifically test the drug against my mold?
Will this drug interact with any of my other medications?
How do you know if the medication is working?
What are the side effects?
What is the cost of the medication? How will you help me with insurance?
What will we do if it does not work?
Can we do anything to help my immune system fight the infection?
Will I need any other treatments (e.g., surgery)?

Click here to download and print a PDF of these questions.