Tolerance and efficacy of Amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in haematological patients.

Abstract

The tolerance of aerosolised amphotericin B as prophylaxis against invasive pulmonary aspergillosis was investigated in 61 granulocytopenic periods in 42 patients treated for a haematologic malignancy. Each patient was to receive amphotericin B in doses escalating to 10 mg three times daily (t.i.d.), but only 20 (48%) patients managed to complete the scheduled regimen. One patient tolerated the full dose initially, but had to discontinue treatment when dyspnea developed as a result of pneumonia and acute respiratory distress. Another 22 patients (52%) experienced side effects, including eight (19%) who reported mild coughing and dyspnea but who tolerated the full dose and three (7%) patients whose dose was reduced to 5 mg t.i.d. Another six (14%) patients could tolerate only 5 mg t.i.d., and five (12%) others stopped treatment because of intolerance. Elderly patients (p < 0.05) and those with a history of chronic pulmonary obstructive disease (p = 0.09) were more likely to develop side effects during inhalation. Twelve (28%) patients developed proven of possible invasive fungal infections, but no correlation was established between infection and the total amount of amphotericin B inhaled. Inhalation of aerosolised amphotericin B is poorly tolerated and does not appear useful in preventing invasive pulmonary aspergillosis in granulocytopenic patients.

• Authors: Z Erjavec, G M Woolthuis, H G de Vries-Hospers, W J Sluiter, S M Daenen, B de Pauw, M R Halie
• Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 16 Issue 5 Pg. 364-8 (May 1997) ISSN: 0934-9723 [Print] Germany
• PMID: 9228476 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antifungal Agents
• Amphotericin B

Topics

• Administration, Inhalation
• Adolescent
• Adult
• Aged
• Agranulocytosis (complications, immunology)
• Amphotericin B (adverse effects, therapeutic use)
• Antifungal Agents (adverse effects, therapeutic use)
• Aspergillosis (etiology, prevention & control)
• Chi-Square Distribution
• Confidence Intervals
• Dose-Response Relationship, Drug
• Female
• Fungemia (etiology, prevention & control)
• Hematologic Neoplasms (complications, immunology)
• Humans
• Lung Diseases, Fungal (etiology, prevention & control)
• Male
• Middle Aged
• Treatment Outcome