Aerosolized Amphotericin B and Immunocompromised Patients

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Patients with compromised immunosystems- such as those with HIV, leukemia, lymphoma, severe malnutrition, or on immunosuppressive drugs for bone or organ transplant- are at high risk for invasive pulmonary aspergillosis (ie. Infection with Aspergillus fungi).     

Aerosolized Amphotericin B May Be Helpful to Reduce Risk of Invasive Pulmonary Aspergillosis in Immunocompromised Patients

Di Xia et al. Aerosolized amphotericin B as prophylaxis for invasive pulmonary aspergillosis: a meta-analysis. International Journal of Infectious Diseases 2014; In Press

Between 2 to 20% of bone and organ transplant patients develop invasive aspergillosis. Even with intensive treatment with antifungal drugs- invasive pulmonary aspergillosis is fatal about 60% of the time. It is often difficult to diagnose invasive pulmonary aspergillosis in its early and more treatable stage. Therefore, effective prophylactic antifungal treatments are badly needed for immunocompromised patients.

Amphotericin B is an antifungal drug which is fairly effective in treating Aspergillus infections. However, intravenous amphotericin B has many common adverse side effects including high fevers, chills, hypotension, shaking, vomiting, headache, and drowsiness. Use of aerosolized amphotericin B in the lung has a much lower risk of side effects than intravenous amphotericin B and may be effective in preventing invasive pulmonary aspergillosis. A meta-analysis of 2 studies involving 768 immunocompromised human patients reported that use of prophylactic aerosolized amphotericin B reduced risk of invasive pulmonary aspergillosis by 58% (OR 0.42, 95% CI 0.22-0.79). A meta-analysis of 6 studies with immunocompromised lab animals reported that use of prophylactic aerosolized amphotericin B reduced risk of invasive pulmonary aspergillosis by 87% (OR 0.13, 95% CI 0.08-0.21).
 

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