The high incidence of invasive aspergillosis (IA) in 'at-risk' patient populations, combined with poor treatment outcomes, necessitates the application of novel prevention and management strategies. Among such strategies is administration of antifungal agents using alternate routes of administration (such as local injections, irrigations, and aerosols). In general, such strategies are used adjunctively to systemic administration of antifungals and/or surgical intervention for treatment-refractory infections. Adequately-controlled clinical trials are lacking with many of these therapies to justify routine use as a primary prophylaxis or treatment strategy. Aerosolized administration of various formulations of amphotericin B has found more widespread acceptance, especially in the prevention of invasive aspergillosis in patients at highest risk. Given the pharmacokinetics, safety and efficacy of newer treatment options, the need for such novel administration for prevention and management of IA will need to be re-evaluated in the future.
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