Aerosol Chemotherapy in Bronchopulmonary Candidiasis

Abstract

One of the most frequent complications encountered in non-specific respiratory pathology of recent years is overinfection by Candida albicans. An important contributive factor is the recent massive anti-biotherapy, above all with tetracyclines, favouring this overinfection. Since at present the treatment of bronchopulmonary processes is difficult owing to the lack of an effective oral or parenteral therapy, a study was carried out of 33 patients treated with nystatin and amphotericin B in aerosol form, with 3-4 sessions of treatment per day, during a minimum of 10 days. At each session either 50,000 U of nystatin or 5 mg of amphotericin B were administered. The results obtained showed that after treatment, C. albicans was no longer present in the sputum of 84% of cases treated. In view of these results it is considered that – at present – the two most suitable substances for the treatment of pulmonary candidiases are nystatin and amphotericin B in aerosol form.

Novel aspect of amphotericin B action: accumulation in human monocytes potentiates killing of phagocytosed Candida albicans

“…The possibilities of local amphotericin B application are also receiving increased attention. Aerosol application, first described nearly 20 years ago (23), and low-dose intravenous application are emerging as prophylactic measures against pulmonary fungal infections in neutropenic patients (13,20,29).…”

Novel modes of antifungal drug administration

“…Data from eight dogs and one human patient following AmBd inhalations were first reported in 1959 [17], followed by a report of aerosolised nystatin and amphotericin B use in 1975 [18]. Since that time, numerous case reports and clinical trials have been published evaluating the use of both AmBd and lipid-based formulations of amphotericin B as aerosols for both the prevention and treatment of pulmonary fungal infections .…”

“…One of these reports [19] describes the formulation as 500,000 units of nystatin (Mycostatin  , Squibb) in 15 ml of distilled water, which was administered by nebulisation of the solution over 1 h. While successful results were achieved in both cases, one patient [20] later relapsed and required additional therapy with inhaled nystatin. Aerosolised nystatin 50,000 units two-to four-times daily has also been compared with aerosolised amphotericin B 5 mg two-to four-times daily in a clinical trial of 33 patients with bronchopulmonary C. albicans infection [18]. A total of 84% of cases (21 of 25) treated with nystatin aerosol achieved cures (with Candida being eliminated from their sputum).…”

“…Despite its original description in the late 1950s as intravenous therapy for invasive mycoses, most of the clinical data on the use of aerosolised AmBd was not published until the 1990s. Data regarding this use of aerosolised AmBd in the treatment of pulmonary fungal infections, in conjunction with systemic antifungal agents, exist only in the form of case reports [17,18,[31][32][33][34]37,38]. Recent studies have focused on its potential role as a primary prophylaxis against pulmonary fungal infections (primarily invasive aspergillosis [IA]) in the immunocompromised patient population [22][23][24][25][26][27][28][29].…”

“…The use of AmBd aerosol for the specific treatment of fungal infection in humans was first described in 1959 by Oehling A et al [18] Broncho-pulmonary candidiasis IH nystatin 50,000 units 2 -4 times/day x 10 days or IH AmBd 5 mg 2 -4 times/ day x 10 days Total = 33 Nystatin = 24 AmBd = 9…”