Amphotericin B with and without itraconazole for invasive aspergillosis: A three-year retrospective study.
BACKGROUND
Treatment of invasive aspergillosis is frequently unsuccessful, so innovations in therapy are needed. Clinical studies demonstrate that itraconazole may be an effective alternative to amphotericin B. Itraconazole also has been combined with amphotericin B in animal models of aspergillosis, but this regimen produced antagonistic effects.


OBJECTIVE
To determine the role of itraconazole in the adjunctive treatment of invasive aspergillosis.


METHODS
A review was conducted of all patients with definite or probable aspergillosis from January 1995 to December 1997 who were treated with conventional amphotericin B alone or in combination with itraconazole.


RESULTS
Of 21 patients, 10 received amphotericin B and 11 received the combination. The two groups of patients were comparable clinically at baseline (including similar mean APACHE III scores). Both groups received similar doses and days of amphotericin B treatment. Of the patients who received combination therapy, nine (82%) were cured or improved, and of those who received only amphotericin B, five (50%) were cured or improved.


CONCLUSIONS
This study demonstrates that itraconazole and amphotericin B given together are not clinically antagonistic and that the promise of combination therapy for aspergillosis should be evaluated further in a randomized clinical trial.
Popp
A I
AI
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
White
M H
MH
Quadri
T
T
Walshe
L
L
Armstrong
D
D
D018806:APACHE; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B