CF and Aspergillus

Question

Hello. I'm the mother of a 30-year-old daughter diagnosed with CF. I wanted to ask about treatments for aspergillus infections. Aspergillus is minimally sensitive to Itraconazole. Last year the aspergillus went away after a 14-day treatment with voriconazole – we've been without aspergillus for 9 months.
We know that voriconazole is a very expensive medicine. Our doctor confirmed that the medication cannot be prescribed because of its price. Please advise us on whether the medicine can be approved by a reviewing doctor or something similar. My daughter is colonised by staphylococcus aureus; she does not have either pseudomonas aeruginosa or Burkholderia cepacia.
I am convinced that some form of assistance exists.
Thanks in advance for your advice and best wishes for continued success.
Vera Sefrova

Answer

Hello.
We're sorry for the delayed response, but unfortunately the answer to your question is not a straightforward one and the Health Ministry's regular changes mean it is changing.
Voriconazole really is a very expensive medicine and it cannot be prescribed by every doctor; only doctors specializing in hematology, oncology and infectious medicines can prescribe it.
Of course, you can apply for an exemption and approval of indications by a reviewing doctor, but the results can vary from doctor to doctor and from health insurer to health insurer.
Your daughter's symptoms with her aspergillus infection are also very important, and whether this is so-called allergic bronchopulmonary aspergillosis. The possibilities for the treatment of this complication, which is frequently connected with CF, and the results of aspergillus infections in the body are more complex than the option of itraconazole or voriconazole.
Please consult with an attending physician who knows your daughter very well on how to best resolve the given situation.
Best regards, Libro Fila and Jitka Brazova

19.01.2009