This review summarizes the literature on inhaled
amphotericin B for invasive
aspergillosis prophylaxis in patients with
neutropenia secondary to
hematologic malignancy treatment or stem cell transplant. Six trials, 2 randomized controlled and 4 with historical controls, were identified. Three inhaled
amphotericin B deoxycholate trials found a reduced invasive
aspergillosis incidence, 1 reaching statistical significance. Three inhaled
liposomal amphotericin B trials demonstrated similar reductions with 2 finding statistical significance. Relative risk reductions for invasive
aspergillosis were routinely 40-60%. Both formulations were without reported systemic or severe adverse effects. The most common adverse events were
cough, bad taste, and
nausea. Discontinuation rates ranged from 0-45%. The only randomized, placebo-controlled trial utilized inhaled
liposomal amphotericin B reported a nearly 60% relative risk reduction. Inhaled
liposomal amphotericin B 12.5 mg twice weekly is an alternative for invasive
aspergillosis prophylaxis in high risk neutropenic patients with
hematologic malignancies and stem cell transplant recipients when recommended
azole agents are contraindicated or should not be used.