title: In vitro characterization of nebulizer delivery of liposomal amphotericin B aerosols.
abstract: Pharmaceutical aerosols have the potential to prevent pulmonary infectious diseases. Liposomal amphotericin B (LAMB, Ambisome, Astellas Pharma US, Deerfield, IL, USA) is approved as an intravenous infusion for empiric treatment of presumed fungal infections in neutropenic, febrile patients, as well as patients infected with Aspergillus, Cryptococcus, and other fungal pathogens. In this study, four different nebulizers were tested for their ability to deliver LAMB in aerodynamic droplet-size ranges relevant to lung deposition by an inertial sampling technique Mass median aerodynamic diameter (MMAD) and fine particle fraction percent <3.3 μm (FPF(3.3)) and <5.8 μm (FPF(5.8)) were determined by cascade impaction during a 2 min sampling period for each of three trials of all nebulizers. The MMADs for all nebulizers ranged from 1.72 ± 0.11 μm to 2.89 ± 0.12 μm; FPF(3.3) and FPF(5.8) were approximately 80% and 90%, respectively. Although all nebulizers appear acceptable for delivery of LAMB, the Pari LC Star and the Aeroeclipse II were considered the best in terms of delivery of aerosol efficiently and the proportion suitable for lung deposition. Additional research on pulmonary delivery and clinical tolerability is warranted.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC 27710, USA. alexa011@mc.duke.edu
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Winkler
authors.forename: Shuai
authors.initials: S
authors.lastname: Shi
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Dodds Ashley
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Hickey
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D004867:Equipment Design; D009330:Nebulizers and Vaporizers; D010316:Particle Size
chemical_list: D000336:Aerosols; D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B