Intravenous Itraconazole Followed by Oral Itraconazole in the Treatment of Invasive Pulmonary Aspergillosis in Patients with Hematologic Malignancies, Chronic Granulomatous Disease, or AIDS

Caillot, Denis; Bassaris, Harry P.; McGeer, Allison; Arthur, Chris; Prentice, H. G.; Seifert, Wilfried; Beule, K. De

doi:10.1086/323020

Cited by 151 publications

(66 citation statements)

References 28 publications

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“…The oral itraconazole solution has a better bio-availability than capsules and allows more stable blood levels. Serum concentration of itraconazole should be maintained at around 1,000 ng?mL -1 for itraconazole and its derivatives (.250 ng?mL [145]. The main limitations of itraconazole use are related to its numerous drug interactions (including some benzodiazepines used in the intensive care unit for sedation), its poor bioavailability, as well as its negative inotropic effect that forces caution when administered to a patient suffering from cardiac heart failure or shock [146].…”

Section: Curative Treatments Amphotericin B and Itraconazolementioning

confidence: 99%

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Bulpa¹,

Dive²,

Sibille³

2007

European Respiratory Journal

310

200

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Aspergillus spp. cultured in specimens from the airways of chronic obstructive pulmonary disease (COPD) patients are frequently considered as a contaminant. However, growing evidence suggests that severe COPD patients are at higher risk of developing invasive pulmonary aspergillosis (IPA), although IPA incidence in this population is poorly documented. Some data report that COPD is the underlying disease in 1% of patients with IPA.Definitive diagnosis of IPA in COPD patients is often difficult as tissue samples are rarely obtained before death. Diagnosis is therefore usually based on a combination of clinical features, radiological findings (mostly thoracic computed tomography scans), microbiological results and, sometimes, serological information.Of 56 patients with IPA reported in the literature, 43 (77%) were receiving corticosteroids on admission to hospital. Breathlessness was always a feature of disease and excess wheezing was present in 79% of patients. Fever (.38uC) was present in only 38.5%. Chest pain and haemoptysis were uncommon. Six out of 33 (18%) patients had tracheobronchitis observed during bronchoscopy. The median delay between symptoms and diagnosis was 8.5 days. The mortality rate was high: 53 out of 56 (95%) patients died despite invasive ventilation and antifungal treatment in 43 (77%) of them.In chronic obstructive pulmonary disease patients, invasive pulmonary aspergillosis currently carries a very poor prognosis. Outcome could perhaps be improved by more rapid diagnosis and prompt therapy with voriconazole.

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Section: Curative Treatments Amphotericin B and Itraconazolementioning

confidence: 99%

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Bulpa¹,

Dive²,

Sibille³

2007

European Respiratory Journal

310

200

View full text Add to dashboard Cite

show abstract

“…For therapy of IPA in patients with persistent immunosuppression, the administration of an intravenous formulation is preferable, as this ensures a more rapid response (BIII) [106]. In a noncomparative study involving a limited number of patients, intravenous itraconazole followed by oral administration showed a response rate of 48% but had to be discontinued due to intolerability in one third of the patients [10]. Randomized studies comparing intravenous itraconazole with polyenes or other azoles in patients with IPA are not available.…”

Section: Azolesmentioning

confidence: 99%

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Böhme¹,

et al. 2008

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International audienceInvasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection

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“…La mayoría de publicaciones describen la eficacia de la formulación oral en pacientes que no están gravemente inmunodeprimidos y existe poca experiencia con la formulación intravenosa de reciente aparición; aunque se describen resultados esperanzadores, respecto a seguridad y eficacia, con la utilización intravenosa seguida de la oral 11 . Esta formulación podría ser una opción de tratamiento primario en pacientes muy seleccionados, clínicamente estables y poco inmunodeprimidos 12 .…”

Section: Tratamiento Antifúngicounclassified

Recomendaciones para el tratamiento de la infección por Aspergillus spp.

Gavaldá¹,

Ruíz²

2003

Enferm Infecc Microbiol Clin

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más de un órgano. Las manifestaciones clínicas son diferentes según la enfermedad de base del paciente.Aspergillus spp. puede causar cinco tipos diferentes de enfermedad: la aspergilosis cutánea primaria, que es una forma de enfermedad localizada pero con la posibilidad de diseminación. La aspergilosis pulmonar, que es la forma de presentación más frecuente en los pacientes neutropénicos (80-90%), sobre todo en la forma aguda invasiva. La variante crónica necrosante es menos frecuente y se observa en pacientes con infección por virus de la inmunodeficiencia humana (VIH), enfermedad granulomatosa crónica, alcoholismo y tratamiento prolongado con corticoides (neumopatías crónicas). La enfermedad de vía aérea, que puede presentarse como traqueobronquitis con o sin invasión en forma de úlceras o nódulos, se denomina traqueobronquitis invasiva o aspergilosis bronquial invasiva, y es casi exclusiva del paciente trasplantado de pulmón. La sinusitis por Aspergillus es también más frecuente en el paciente neutropénico (5-10%). Finalmente, desde los pulmones, Aspergillus spp., mediante angioinvasión puede diseminar a casi cualquier órgano del cuerpo, especialmente el cerebro, hígado, bazo y el tracto gastrointestinal produciendo una enfermedad diseminada. La infección invasiva por Aspergillus spp. presenta una elevada mortalidad dependiendo de su localización que puede oscilar entre el 37% en las formas traqueobronquiales hasta ser superior al 80% en las formas diseminadas con afectación del sistema nervioso central (SNC) a pesar de la utilización de anfotericina B 2 .A. fumigatus es la especie que con más frecuencia causa enfermedad invasiva en enfermos inmunodeprimidos. Otras especies implicadas son: A. flavus, A. niger, A. terreus, A. nidulans, A. versicolor, A. glaucus, etc. A. niger se aísla más a menudo en casos de otomicosis y como colonizante.Para intentar disminuir la elevada mortalidad relacionada con la infección fúngica invasiva, es imprescindible realizar un diagnóstico lo más precoz posible y administrar un tratamiento antifúngico agresivo 3 . Aunque no siempre es posible, debe intentarse disminuir o retirar la inmunosupresión o bien, aumentar la capacidad inmunológica de defensa del huésped y la cifra de neutrófilos.El diagnóstico precoz y el inicio inmediato del tratamiento, deberían reducir la mortalidad relacionada con esta infección. El problema reside en que en la actualidad no están a nuestra disposición técnicas que permitan esta aproximación terapéutica-diagnóstica. La utilización de técnicas como la reacción en cadena de la polimerasa (PCR) (específica para Aspergillus spp. o general para la detección de cualquier hongo o levadura-panfungal) o la detección de antígeno de Aspergillus spp., han demostrado su eficacia en el paciente con leucemia o trasplantado de órgano sólido, Guidelines for the treatment of infection due to Aspergillus spp. IntroducciónEn esta reunión de consenso se abordó únicamente la aspergilosis invasiva, no se establecieron recomendaciones para el tratamiento del aspergiloma...

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Intravenous Itraconazole Followed by Oral Itraconazole in the Treatment of Invasive Pulmonary Aspergillosis in Patients with Hematologic Malignancies, Chronic Granulomatous Disease, or AIDS

Cited by 151 publications

References 28 publications

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Recomendaciones para el tratamiento de la infección por Aspergillus spp.

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