Do you continue voriconazole beyond the minimum recommended duration in a patient with invasive pulmonary aspergillosis who is clinically improved but has persistent radiographic abnormalities on CT?

The "recommended" duration is based on expert opinion, rather than trials. The immune status of the patient counts. When I was taught how to treat invasive aspergillosis at the National Cancer Institute (this was before voriconazole was available), the recommendation was to continue treatment until the CT stops evolving and then "top it off" with 4 extra weeks. This may be excessive across the board, but with azoles it seems fairly safe. What I never do is give a specific time decided in advance...