Use of intracavitary amphotericin B in a patient with aspergilloma and recurrent hemoptysis

Cochrane, L. James; Morano, James U.; Norman, Joe R.; Mansel, J. Keith

doi:10.1016/0002-9343(91)90647-g

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Rates of complete resolution have been reported in two small case series (n = 4 and 7) to be between 42 and 75% [95,98]. Overall, 11 out of 14 patients described in case reports have been successfully treated with percutaneous catheter instillations of amphotericin B [90,91,[94][95][96][97]99]. It is likely, however, that such incidence may be overestimated due to reporting bias of successful therapies.…”

Section: Amphotericin Bmentioning

confidence: 87%

“…Most reports have utilised amphotericin B 50 mg in 20 ml of D5W [94,95,98,99]. The total dose given most frequently was 500 mg [98,99], although total doses as high as 3 g have been reported [96].…”

Section: Amphotericin Bmentioning

confidence: 96%

“…Percutaneous therapy has generally been considered to be a last resort, only attempted when surgical options are either contraindicated or refused by the patient [87]. It has only been described in the published literature for use in the treatment of pulmonary aspergilloma, often associated with haemoptysis [87][88][89][90][91][92][93][94][95][96][97][98][99]. Patients usually had some form of underlying pulmonary disease that would facilitate the development of Aspergillus infection, such as prior pulmonary tuberculosis [88][89][90]95,96], sarcoidosis [88,[97][98][99], bullous lung disease [98], bronchiectasis [99], chronic obstructive pulmonary disease (COPD) [99], pulmonary fibrosis [88], previous radiation therapy [89] and asthma [91].…”

Section: Percutaneous Deliverymentioning

confidence: 99%

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Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.

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Section: Amphotericin Bmentioning

confidence: 87%

Section: Amphotericin Bmentioning

confidence: 96%

Section: Percutaneous Deliverymentioning

confidence: 99%

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Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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“…There have been several reports describing the use of intracavitary therapy to treat aspergilloma (2)(3)(4)(5). Intracavitary therapy offers a numberof advantages: no loss of lung function, ease and rapidity of catheter insertion, prompt response to treatment, relatively short hospitalization, and the possibility to repeat the procedure in the sameor another cavity if necessary (3).…”

Section: Introductionmentioning

confidence: 99%

Empyema Following the Percutaneous Instillation of Antifungal Agents in Patients with Aspergillosis.

et al. 1996

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Wereport two cases of empyema as a complication of the percutaneous instillation of antifungal drugs for pulmonary and pleural aspergillosis.Case 1 underwent percutaneous administration of amphotericin B and fluconazole for 2 months. Six months later, the patient was found to have an Aspergillus empyemawith a bronchopleural fistula. Case 2 with pulmonary and pleural aspergillosis underwent percutaneous administration of amphotericin B for one month. Four months later, the patient underwent pleural drainage due to empyema. Pleural biopsy revealed pleural aspergillosis. In both cases, it was suggested that the preceding Aspergillus infection and percutaneous instillation of antifungals resulted in the development of empyema. (Internal Medicine 35: 657-659, 1996)

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“…For example, Shapiro et al [48] reported the case of suc cessful treatment of 4 patients with acute hemoptysis by a percutaneously placed catheter and intracavitary infusion of amph B (total of 500 mg); /V-acetylcystein was also given in order to facilitate the dissolution of the fungus ball and to help clearing the debris, and in one occasion, the in stillation o f aminocaproic acid was also utilized. Cochrane et al [49] also used intracavitary amph B to treat aspergillorna and recurrent hemoptysis. Intracavitary instillation of amph B (delivered by a flexible fiberoptic broncho scope) had a beneficial effect on a patient with chronic necrotizing pulmonary aspergillosis (an indolent locally invasive form of Aspergillus infection [50]).…”

Section: Aspergillus-induced Peritonitis Intraperitonealmentioning

confidence: 99%

Treatment and Developmental Therapeutics in Aspergillosis. 1. Amphotericin B and Its Derivatives

Georgiev

1992

Respiration

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In recent years, the frequency of infections caused by Aspergillus sp. has been on the rise. Immunocompromised patients are especially vulnerable to such infections. The polyene antibiotic amphotericin B is currently considered to be therapeutically the most effective drug against Aspergillus-induced infections. In the present review, the clinical efficacy of amphotericin B, its toxicities and various routes of applications, are discussed. Different combinations of amphotericin B with other drugs have also been reviewed, along with the anti-Aspergillus activity of various other antibiotics and some ester derivatives of amphotericin B.

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Use of intracavitary amphotericin B in a patient with aspergilloma and recurrent hemoptysis

Cited by 6 publications

References 7 publications

Novel modes of antifungal drug administration

Novel modes of antifungal drug administration

Empyema Following the Percutaneous Instillation of Antifungal Agents in Patients with Aspergillosis.

Treatment and Developmental Therapeutics in Aspergillosis. 1. Amphotericin B and Its Derivatives

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