Inhaled amphotericin B for prophylaxis against invasive Aspergillus infections.

Abstract

OBJECTIVE:

To evaluate the available literature describing the use of inhaled amphotericin B for prophylaxis of invasive Aspergillus spp. infections.

DATA SOURCES:

A MEDLINE search was conducted (1966-July 2006) using the key terms amphotericin B, inhaled amphotericin B, Aspergillus spp., invasive aspergillosis, solid-organ transplant, neutropenia, and inhalation. Review of the reference lists of the identified articles was also performed.

STUDY SELECTION AND DATA EXTRACTION:

Study selection included published trials, case reports, and case series of humans with hematologic disease and solid-organ transplant who used inhaled amphotericin B in the prevention of invasive Aspergillus infections.

DATA SYNTHESIS:

Inhaled amphotericin B has been evaluated for the prevention of invasive aspergillosis (IA) infections in neutropenic patients and certain solid-organ transplant recipients. Use of inhaled amphotericin B seems to reduce the incidence of IA in these patients; however, some of the clinical evidence was limited by factors such as small sample sizes, lack of statistical analyses, and lack of power to detect a difference between prophylaxis and control groups. Although the clinical evidence supporting the use of inhaled amphotericin B has some limitations, its use still may be beneficial for the prophylaxis of invasive Aspergillus infections, especially in solid-organ transplant recipients where the evidence is strongest.

CONCLUSIONS:

Invasive Aspergillus infections are becoming more prevalent in high-risk populations (eg, patients with malignancies, following bone marrow transplantation, or following solid-organ transplantation). The mortality rates associated with IA are great in these populations, making prophylaxis an important consideration. Inhaled amphotericin B has recently come into vogue as an option for prophylaxis against IA. Some of the data available supports the use of inhaled amphotericin B for the prevention of IA while providing evidence of fewer drug interactions and toxicities associated with other antifungal agents.

• Authors: Rima A Mohammad, Kristin C Klein
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 40 Issue 12 Pg. 2148-54 (Dec 2006) ISSN: 1542-6270 [Electronic] United States
• PMID: 17148653 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Amphotericin B

Topics

• Administration, Inhalation
• Amphotericin B (administration & dosage)
• Aspergillosis (drug therapy, epidemiology, prevention & control)
• Humans
• Immunocompromised Host (drug effects)
• Retrospective Studies
• Transplantation (adverse effects)