What is the preferred antifungal for invasive aspergillosis?

• A. Amphotericin B
• B. Voriconazole
• C. Caspofungin
• D. Fluconazole

Answer: (B)

Invasive aspergillosis requires an antifungal with strong activity against molds and proven survival benefit. Voriconazole fits that role as the preferred first-line agent because of its potent activity against Aspergillus species and data showing improved survival compared with amphotericin B. It also penetrates well into tissues and the central nervous system, which matters with disseminated disease. Amphotericin B is effective but has greater toxicity, especially nephrotoxicity, and overall outcomes are not as favorable as with voriconazole in many cases. Fluconazole does not cover Aspergillus, so it isn’t suitable. Caspofungin has activity against Aspergillus but is not typically used as first-line monotherapy for invasive disease. Therefore, voriconazole is the best initial choice.