Tolerance and efficacy of Amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in haematological patients.
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.
Erjavec
Z
Z
Department of Haematology, University Hospital Groningen, The Netherlands.
Woolthuis
G M
GM
de Vries-Hospers
H G
HG
Sluiter
W J
WJ
Daenen
S M
SM
de Pauw
B
B
Halie
M R
MR
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000380:Agranulocytosis / Q000150:complications / Q000276:immunology; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001228:Aspergillosis / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D005260:Female; D016469:Fungemia / Q000209:etiology / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000276:immunology; D006801:Humans; D008172:Lung Diseases, Fungal / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B