Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients

Behre, Gerhard; Schwartz, Sophia; Lenz, K.; Ludwig, W.-D.; Wandt, Hannes; Schilling, E.; Heinemann, V.; Trittin, A.; Boenisch, O.; Treder, W.; Siegert, W.; Hiddemann, W.; Beyer, J.

doi:10.1007/s002770050120

Cited by 12 publications

(13 citation statements)

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“…Aerosolized medication regimens are an attractive option, as drug interactions and systemic toxicities are likely to be limited (4, 5). Several centers have reported on the safety of aerosolized amphotericin B deoxycholate (AmBd) with a variety of dosing regimens (6–9). A few centers have reported on the safety of aerosolized amphotericin B lipid complex (ABLC) (5, 10–12).…”

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confidence: 99%

Safety of aerosolized liposomal versus deoxycholate amphotericin B formulations for prevention of invasive fungal infections following lung transplantation: a retrospective study

Lowry

Marty

Vargas

et al. 2007

Transplant Infectious Dis

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confidence: 99%

Safety of aerosolized liposomal versus deoxycholate amphotericin B formulations for prevention of invasive fungal infections following lung transplantation: a retrospective study

Lowry

Marty

Vargas

et al. 2007

Transplant Infectious Dis

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“…Lipid‐based formulations are less nephrotoxic but significantly more expensive and have not been shown to provide effective prophylaxis (Kelsey et al , 1999). The efficacy of low doses intravenously or nebulized formulations by inhalation is also unproven (Behre et al , 1997; Perfect et al , 1992; Riley et al , 1994; Tsourounis & Guglielmo, 1996). Orally administered polyenes (amphotericin B and nystatin) provide less effective prophylaxis than fluconazole (Philpott‐Howard et al , 1993).…”

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confidence: 99%

A randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with haematological malignancies

et al. 1999

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Summary.Fluconazole is widely used as antifungal prophylaxis but it is ineffective against Aspergillus. Itraconazole has a broader spectrum of activity but the capsules give erratic bioavailability in neutropenic patients. We compared itraconazole oral solution (which has an improved pharmacokinetic profile) with fluconazole for antifungal prophylaxis.Adults with haematological malignancies receiving chemotherapy or bone marrow transplants were randomly allocated 5 mg/kg/d itraconazole (itra) solution (288 episodes) or 100 mg fluconazole suspension (flu) (293 episodes) from before the onset of neutropenia until neutrophil recovery or suspected fungal infection. Outcomes were assessed by independent reviewers unaware of the prophylaxis allocation.More proven systemic fungal infections occurred in flu (Aspergillus four, Candida tropicalis one, C. krusei one) than itra (C. albicans one) and more of these were fatal (four versus nil). This difference reached statistical significance when first study episodes were considered separately (six flu versus nil itra, P ¼ 0·03). Significantly more deaths of presumed fungal origin occurred in flu than itra (seven versus nil, P ¼ 0·024). There were significantly more cases of proven aspergillosis in flu than itra (six versus nil, P ¼ 0·038, 5/6 cases were fatal) if those occurring outside the study period are included. Significantly more patients receiving flu required amphotericin B (58 v 39, P ¼ 0·043) but this may have been affected by the fact that the study was not blinded. There were 11 proven mucosal candidal infections in flu and four in itra.Itraconazole solution and fluconazole provide effective prophylaxis against Candida but itraconazole affords greater protection against fatal aspergillosis.

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“…It will not have any influence on the course of disease in patients who may have acquired the fungus before they are admitted. Also there are no data to show that it is even effective in this context ( 40), and even when administered properly it is poorly tolerated ( 41).…”

Section: Strategies For Managing Ifidmentioning

confidence: 99%

A strategy for managing fungal infections in haematopoietic stem cell transplantation

Donnelly

2000

Transplant Infectious Dis

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As more indications continue to be found for allogeneic haematopoietic transplantation, more patients are at risk for invasive fungal infectious diseases (IFID), particularly candidiasis and aspergillosis. Risk factors for disease are becoming better defined and diagnostic methods have improved considerably. In addition, there is now international agreement that three elements form the basis for defining IFID (host factors, clinical evidence, and mycological results), that imaging is acceptable for diagnosing disease, and that indirect tests such as antigen detection are also adequate mycological proof of cause. There are also more drugs available and still more to come, offering the potential for selective prophylaxis as well as preemptive and specific therapy, as well as for flexible administration. Hence, all the elements are in place for designing and testing an effective and economically sound strategy for dealing with IFID.

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Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients

Cited by 12 publications

References 0 publications

Safety of aerosolized liposomal versus deoxycholate amphotericin B formulations for prevention of invasive fungal infections following lung transplantation: a retrospective study

Safety of aerosolized liposomal versus deoxycholate amphotericin B formulations for prevention of invasive fungal infections following lung transplantation: a retrospective study

A randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with haematological malignancies

A strategy for managing fungal infections in haematopoietic stem cell transplantation

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