title: A pilot study of prophylactic aerosolized amphotericin B in patients at risk for prolonged neutropenia.
abstract: Invasive aspergillosis continues to be a significant cause of morbidity and mortality in patients with prolonged neutropenia. We performed a phase I trial of escalating doses of aerosolized amphotericin B given by a face mask nebulizer system with a disposable bacterial exhale filter. Five, 10, 15, and 20 mg of drug were dissolved in sterile water and inhaled over 10 to 15 minutes twice daily. Tolerance was studied in 26 patients (18 transplant recipients, and 8 leukemia patients). No side effects were observed at any dose level. Prophylactic treatment ended for 14 patients (54%) when intravenous (IV) amphotericin B was begun empirically for antifungal coverage following fevers. Eleven patients (43%) continued inhaled amphotericin B until blood counts recovered. One patient was taken off study when she developed cardiogenic pulmonary edema. No patient developed clinically suspicious or pathologically documented infection with invasive aspergillosis. Prophylactic aerosolized amphotericin B is well tolerated at 5, 10, 15, and 20 mg twice daily dosing. In addition, prophylactic aerosolized amphotericin B does not appear to sensitize patients to the subsequent use of IV amphotericin B. Although this study suggests that prophylactic inhaled amphotericin B is well tolerated and effective, a large scale controlled trial is needed.
authors: University of Chicago Medical Center, Department of Medicine, Illinois 60637.
authors: S E
authors: SE
authors: Myers
authors: S M
authors: SM
authors: Devine
authors: R L
authors: RL
authors: Topper
authors: M
authors: M
authors: Ondrey
authors: C
authors: C
authors: Chandler
authors: K
authors: K
authors: O'Toole
authors: S F
authors: SF
authors: Williams
authors: R A
authors: RA
authors: Larson
authors: R B
authors: RB
authors: Geller
mesh_terms: D000328:Adult; D000336:Aerosols; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D001228:Aspergillosis / Q000453:epidemiology / Q000517:prevention & control*; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007938:Leukemia / Q000150:complications / Q000188:drug therapy; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D009894:Opportunistic Infections / Q000517:prevention & control*; D010865:Pilot Projects
chemical_list: D000336:Aerosols; D000666:Amphotericin B